Provider Demographics
NPI:1922687813
Name:CRUZ, LUIS A
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 HUNTER AVE APT 15A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5637
Mailing Address - Country:US
Mailing Address - Phone:929-331-9692
Mailing Address - Fax:
Practice Address - Street 1:2420 HUNTER AVE APT 15A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5637
Practice Address - Country:US
Practice Address - Phone:929-331-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2023-05-25
Deactivation Date:2023-04-27
Deactivation Code:
Reactivation Date:2023-05-18
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY002500-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency