Provider Demographics
NPI:1801694617
Name:BECERRA CRUZ, MADELEY
Entity type:Individual
Prefix:
First Name:MADELEY
Middle Name:
Last Name:BECERRA CRUZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12031 SW 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3918
Mailing Address - Country:US
Mailing Address - Phone:786-554-5158
Mailing Address - Fax:
Practice Address - Street 1:12031 SW 191ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3918
Practice Address - Country:US
Practice Address - Phone:786-554-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide