Provider Demographics
NPI:1215458765
Name:CRUZ PALENZUELA, NILIEN
Entity type:Individual
Prefix:
First Name:NILIEN
Middle Name:
Last Name:CRUZ PALENZUELA
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 1:18024 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3006
Mailing Address - Country:US
Mailing Address - Phone:786-719-8502
Mailing Address - Fax:
Practice Address - Street 1:18024 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:786-719-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:2019-10-10
Deactivation Code:
Reactivation Date:2020-05-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician