1962723866 NPI number — MS. MICHELLE LIZZETTE CRUZ MSW

Table of content: MS. MICHELLE LIZZETTE CRUZ MSW (NPI 1962723866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962723866 NPI number — MS. MICHELLE LIZZETTE CRUZ MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
MICHELLE
Provider Middle Name:
LIZZETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962723866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10600 BLOOMFIELD DR
Provider Second Line Business Mailing Address:
APT. 211
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32825-5903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-772-7324
Provider Business Mailing Address Fax Number:
407-862-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10600 BLOOMFIELD DR
Provider Second Line Business Practice Location Address:
APT. 211
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32825-5903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-772-7324
Provider Business Practice Location Address Fax Number:
407-862-2737
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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