Provider Demographics
NPI:1962010702
Name:CRUZ MARTIN, YADIRA DE LA CARIDAD I
Entity Type:Individual
Prefix:MISS
First Name:YADIRA
Middle Name:DE LA CARIDAD
Last Name:CRUZ MARTIN
Suffix:I
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 1:26005 SW 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5643
Mailing Address - Country:US
Mailing Address - Phone:786-769-9679
Mailing Address - Fax:
Practice Address - Street 1:26005 SW 144TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5643
Practice Address - Country:US
Practice Address - Phone:786-769-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician