Provider Demographics
NPI:1467065243
Name:CRUCES, CRISTIAN
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:CRUCES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29124 SW 134TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5658
Mailing Address - Country:US
Mailing Address - Phone:868-371-6297
Mailing Address - Fax:
Practice Address - Street 1:29124 SW 134TH PATH
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5658
Practice Address - Country:US
Practice Address - Phone:786-837-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20128573106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician