Provider Demographics
NPI:1295428969
Name:CRUZ LEYVA, MARIA DE LOS ANGELES
Entity type:Individual
Prefix:
First Name:MARIA DE LOS ANGELES
Middle Name:
Last Name:CRUZ LEYVA
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 1:16248 SW 83RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5143
Mailing Address - Country:US
Mailing Address - Phone:786-670-5784
Mailing Address - Fax:
Practice Address - Street 1:16248 SW 83RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5143
Practice Address - Country:US
Practice Address - Phone:786-670-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-275685106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician