Provider Demographics
NPI:1639855257
Name:DE LA CRUZ DE LA IGLESIA, MELISSA (CBHCM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DE LA CRUZ DE LA IGLESIA
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 SW 24TH ST APT E204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8058
Mailing Address - Country:US
Mailing Address - Phone:786-630-8663
Mailing Address - Fax:
Practice Address - Street 1:9535 SW 24TH ST APT E204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8058
Practice Address - Country:US
Practice Address - Phone:786-630-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0104918171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator