Provider Demographics
NPI:1912673476
Name:CRUZ HAMILL, BERONICA OFELIA (IFC)
Entity Type:Individual
Prefix:
First Name:BERONICA
Middle Name:OFELIA
Last Name:CRUZ HAMILL
Suffix:
Gender:F
Credentials:IFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-0413
Mailing Address - Country:US
Mailing Address - Phone:260-527-2444
Mailing Address - Fax:
Practice Address - Street 1:3859 S ELAINE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-6272
Practice Address - Country:US
Practice Address - Phone:574-551-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty