MEDICARE: JOSE MANUEL CRUZ CARLO

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	104100000X	Social Worker	12749-M	NV
2	104100000X	Social Worker	8321	PR
3	104100000X	Social Worker	CBHCMS.0102849	FL
4	104100000X	Social Worker	CBHCM.0107457	FL

General Provider Information

NPI Number	:	1508610247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE MANUEL CRUZ CARLO

Provider Business Mailing Address
First Line	:	1687 BUCKEYE FALLS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4347
Country	:	US
Telephone Number	:	407-445-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1687 BUCKEYE FALLS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4347
Country	:	US
Telephone Number	:	407-837-3039
Fax Number	:	689-223-7310

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	12/12/2025

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