Provider Demographics
NPI:1063120053
Name:RAY CRUZ, SOJHAM ANDREINA (RBT)
Entity type:Individual
Prefix:MRS
First Name:SOJHAM
Middle Name:ANDREINA
Last Name:RAY CRUZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 WATEREDGE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7540
Mailing Address - Country:US
Mailing Address - Phone:904-666-5147
Mailing Address - Fax:855-226-6396
Practice Address - Street 1:5600 SPRING PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5989
Practice Address - Country:US
Practice Address - Phone:786-525-3114
Practice Address - Fax:855-226-6396
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-187109106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty