Provider Demographics
NPI:1790130375
Name:CRUZ BETANCOURT, SILVIA
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:CRUZ BETANCOURT
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 1:30 NW 87TH AVE APT C109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7000
Mailing Address - Country:US
Mailing Address - Phone:786-853-5721
Mailing Address - Fax:
Practice Address - Street 1:30 NW 87TH AVE APT C109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7000
Practice Address - Country:US
Practice Address - Phone:786-853-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
251E00000X
FLRBT-20-122562106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107628800Medicaid