Provider Demographics
NPI:1821366931
Name:CRUZ, DILLIANA (SLP)
Entity Type:Individual
Prefix:MS
First Name:DILLIANA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 N BROADWAY
Mailing Address - Street 2:APT. 1F
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2451
Mailing Address - Country:US
Mailing Address - Phone:347-731-7954
Mailing Address - Fax:
Practice Address - Street 1:279 N BROADWAY
Practice Address - Street 2:APT. 1F
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2451
Practice Address - Country:US
Practice Address - Phone:347-731-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011330-1235Z00000X
FLSA 6034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist