Provider Demographics
NPI:1063912566
Name:CRUZ, MARIELA
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:CRUZ
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 1:309 THEOPHILO MANSUR CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-4309
Mailing Address - Country:US
Mailing Address - Phone:646-327-9649
Mailing Address - Fax:
Practice Address - Street 1:309 THEOPHILO MANSUR CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4309
Practice Address - Country:US
Practice Address - Phone:646-327-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator