Provider Demographics
NPI:1154603538
Name:CRUZ, YANIELLIE C
Entity type:Individual
Prefix:MISS
First Name:YANIELLIE
Middle Name:C
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 1:173 CALLE LIRIO
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2212
Mailing Address - Country:US
Mailing Address - Phone:787-980-8151
Mailing Address - Fax:
Practice Address - Street 1:KM 0.4 CARRETERA 857
Practice Address - Street 2:BARRIO CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2212
Practice Address - Country:US
Practice Address - Phone:787-980-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist