Provider Demographics
NPI:1316370554
Name:CHEZ LA CRUZ CATERING
Entity type:Organization
Organization Name:CHEZ LA CRUZ CATERING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:LAFFITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-634-2766
Mailing Address - Street 1:2180 NW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7115
Mailing Address - Country:US
Mailing Address - Phone:305-634-2677
Mailing Address - Fax:305-634-2715
Practice Address - Street 1:2180 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7115
Practice Address - Country:US
Practice Address - Phone:305-634-2677
Practice Address - Fax:305-634-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685887200Medicaid