Provider Demographics
NPI:1215654488
Name:LORENZO CRUZ, ROSA NILA (RBT)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:NILA
Last Name:LORENZO 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 1:6423 ROYAL HUNT DR APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-2496
Mailing Address - Country:US
Mailing Address - Phone:813-500-1312
Mailing Address - Fax:
Practice Address - Street 1:6702 N GUNLOCK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4508
Practice Address - Country:US
Practice Address - Phone:813-644-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-240554106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician