MEDICARE: ELIER 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	106S00000X	Behavior Technician		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	:	1982346318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIER CRUZ

Provider Business Mailing Address
First Line	:	2857 GRAND BEND CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-9185
Country	:	US
Telephone Number	:	786-777-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 W VINE ST STE 124
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4660
Country	:	US
Telephone Number	:	407-483-3074
Fax Number	:

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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Directions to “ ELIER CRUZ ” Practice Location

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