Provider Demographics
NPI:1710570189
Name:CRUZ SANTIAGO, LAISA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LAISA
Middle Name:MICHELLE
Last Name:CRUZ SANTIAGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 MAUSSER DR. APT D2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822
Mailing Address - Country:US
Mailing Address - Phone:787-237-0491
Mailing Address - Fax:
Practice Address - Street 1:1050 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7520
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health