MEDICARE: MRS. MARINELLY CRUZ

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	171R00000X	Interpreter
2	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1285396069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARINELLY CRUZ

Provider Business Mailing Address
First Line	:	5209 HAMM AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1636
Country	:	US
Telephone Number	:	216-512-1463
Fax Number	:	218-215-8593

Provider Business Practice Location Address
First Line	:	5209 HAMM AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1636
Country	:	US
Telephone Number	:	216-512-1463
Fax Number	:	218-215-8593

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

Provider Enumeration Date	:	10/09/2021
Last Update Date	:	02/06/2022

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