Provider Demographics
NPI:1891566295
Name:CRUZ BERGON, AILEN (RN)
Entity Type:Individual
Prefix:
First Name:AILEN
Middle Name:
Last Name:CRUZ BERGON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 NW 12TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1941
Mailing Address - Country:US
Mailing Address - Phone:786-615-2843
Mailing Address - Fax:
Practice Address - Street 1:7270 NW 12TH ST STE 430
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1941
Practice Address - Country:US
Practice Address - Phone:786-615-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9464502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse