MEDICARE: VIVIAN 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	103K00000X	Behavior Analyst

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	:	1518191683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN CRUZ

Provider Business Mailing Address
First Line	:	5724 TYLER ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6340
Country	:	US
Telephone Number	:	786-546-7787
Fax Number	:

Provider Business Practice Location Address
First Line	:	5724 TYLER ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6340
Country	:	US
Telephone Number	:	786-546-7787
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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Directions to “ VIVIAN CRUZ ” Practice Location

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