Provider Demographics
NPI:1215384110
Name:CRUZ, MARISTAILY
Entity Type:Individual
Prefix:
First Name:MARISTAILY
Middle Name:
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 1:11890 SW 8TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1710
Mailing Address - Country:US
Mailing Address - Phone:786-816-6465
Mailing Address - Fax:
Practice Address - Street 1:11890 SW 8TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1743
Practice Address - Country:US
Practice Address - Phone:305-220-6060
Practice Address - Fax:888-247-5059
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician