Provider Demographics
NPI:1376072959
Name:CRUZ, ALEX (COTA DOR)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:COTA DOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4348
Mailing Address - Country:US
Mailing Address - Phone:954-326-1582
Mailing Address - Fax:
Practice Address - Street 1:9211 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2401
Practice Address - Country:US
Practice Address - Phone:954-916-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9755224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant