MEDICARE: MR. JESUS R CRUZ I MED; BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		FL
2	103K00000X	Behavior Analyst	1-21-56289	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225329469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESUS R CRUZ I MED; BS

Provider Business Mailing Address
First Line	:	5300 SW 88TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5109
Country	:	US
Telephone Number	:	954-614-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 SW 88TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5109
Country	:	US
Telephone Number	:	954-614-4855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	03/15/2023

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