Provider Demographics
NPI:1295583649
Name:CRUZ FERNANDEZ, ANNIA M
Entity type:Individual
Prefix:
First Name:ANNIA
Middle Name:M
Last Name:CRUZ FERNANDEZ
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 1:2350 SW 97TH AVE
Mailing Address - Street 2:APT B125
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8004
Mailing Address - Country:US
Mailing Address - Phone:305-747-3274
Mailing Address - Fax:
Practice Address - Street 1:2350 SW 97TH AVE
Practice Address - Street 2:APT B125
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8004
Practice Address - Country:US
Practice Address - Phone:305-747-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-343794106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty