Provider Demographics
NPI:1346939642
Name:FONSECA CRUZ, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:FONSECA 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 1:16452 NW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6308
Mailing Address - Country:US
Mailing Address - Phone:786-375-0036
Mailing Address - Fax:
Practice Address - Street 1:16452 NW 89TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6308
Practice Address - Country:US
Practice Address - Phone:786-375-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician