Provider Demographics
NPI:1619228566
Name:CRUZ, MELISSA LY (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LY
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 GARDEN AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3834
Mailing Address - Country:US
Mailing Address - Phone:305-724-9673
Mailing Address - Fax:
Practice Address - Street 1:3920 GARDEN AVE
Practice Address - Street 2:APT 2
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3834
Practice Address - Country:US
Practice Address - Phone:305-724-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor