Provider Demographics
NPI:1467983445
Name:CRUZ, RHEA LAARNI MUTUC
Entity Type:Individual
Prefix:
First Name:RHEA LAARNI
Middle Name:MUTUC
Last Name: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 1:3500 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2800
Mailing Address - Country:US
Mailing Address - Phone:407-242-4740
Mailing Address - Fax:
Practice Address - Street 1:3500 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2800
Practice Address - Country:US
Practice Address - Phone:407-242-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist