Provider Demographics
NPI:1134734031
Name:DA CRUZ, ROSANGELA MARIANO
Entity type:Individual
Prefix:
First Name:ROSANGELA
Middle Name:MARIANO
Last Name:DA CRUZ
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 1:342 LAKEVIEW DR APT 206
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1360
Mailing Address - Country:US
Mailing Address - Phone:954-682-1997
Mailing Address - Fax:
Practice Address - Street 1:911 E ATLANTIC BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7372
Practice Address - Country:US
Practice Address - Phone:954-941-2323
Practice Address - Fax:954-692-9184
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician