Provider Demographics
NPI:1588209274
Name:CRUZ, KIARA M
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:M
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 1:1689 VILLAGE CENTER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2897
Mailing Address - Country:US
Mailing Address - Phone:630-853-0815
Mailing Address - Fax:
Practice Address - Street 1:1516 E COLONIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4726
Practice Address - Country:US
Practice Address - Phone:407-894-1708
Practice Address - Fax:407-894-1780
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health