Provider Demographics
NPI:1275291064
Name:CRUZ MATOS, LAURA MARYVETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARYVETTE
Last Name:CRUZ MATOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 W SAMPLE RD APT 110
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3693
Mailing Address - Country:US
Mailing Address - Phone:787-231-2261
Mailing Address - Fax:
Practice Address - Street 1:9105 S DADELAND BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7813
Practice Address - Country:US
Practice Address - Phone:305-670-8929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist