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NPI Code Detail

MEDICARE: MISS JENNIFER YVONNE CRUZ

MEDICARE: MISS JENNIFER YVONNE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1780128371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER YVONNE CRUZ
Provider Business Mailing Address
First Line : 30660 SW 188TH AVE
Second Line :
City : HOMESTEAD
State : FL
Zip : 33030-3834
Country : US
Telephone Number : 305-761-6459
Fax Number :
Provider Business Practice Location Address
First Line : 11276 SW 232ND ST
Second Line :
City : GOULDS
State : FL
Zip : 33170-7505
Country : US
Telephone Number : 305-912-8399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2016
Last Update Date : 05/21/2019

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Directions to “ MISS JENNIFER YVONNE CRUZ ” Practice Location

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