Provider Demographics
NPI:1457192866
Name:LARRAMENDI CRUELL, ELIAN
Entity type:Individual
Prefix:
First Name:ELIAN
Middle Name:
Last Name:LARRAMENDI CRUELL
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 1:8828 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1907
Mailing Address - Country:US
Mailing Address - Phone:786-359-8962
Mailing Address - Fax:
Practice Address - Street 1:8828 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1907
Practice Address - Country:US
Practice Address - Phone:786-359-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-32-7108106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty