Provider Demographics
NPI:1104384056
Name:CRUZ, CLARA KARINA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:KARINA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8764 NW 149TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1312
Mailing Address - Country:US
Mailing Address - Phone:305-399-5268
Mailing Address - Fax:
Practice Address - Street 1:7971 RIVIERA BLVD STE 434
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6451
Practice Address - Country:US
Practice Address - Phone:305-859-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty