Provider Demographics
NPI:1407434871
Name:CRUZ ACOSTA, MALENA
Entity Type:Individual
Prefix:
First Name:MALENA
Middle Name:
Last Name:CRUZ ACOSTA
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 1:10905 SW 177TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5075
Mailing Address - Country:US
Mailing Address - Phone:786-907-5163
Mailing Address - Fax:
Practice Address - Street 1:10905 SW 177TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5075
Practice Address - Country:US
Practice Address - Phone:786-907-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician