Provider Demographics
NPI:1245775345
Name:CRUZ-ESPAILLAT, GRISSEEL (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:GRISSEEL
Middle Name:
Last Name:CRUZ-ESPAILLAT
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1864
Mailing Address - Country:US
Mailing Address - Phone:305-596-2226
Mailing Address - Fax:305-596-7077
Practice Address - Street 1:2101 NW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1864
Practice Address - Country:US
Practice Address - Phone:305-596-2226
Practice Address - Fax:305-596-7077
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ23-99. 1603-FOLIO 77405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional