Provider Demographics
NPI:1720648694
Name:CRUZ, XIOMARA
Entity type:Individual
Prefix:
First Name:XIOMARA
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 1:722 PATRICK ST STE 206
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5612
Mailing Address - Country:US
Mailing Address - Phone:407-548-4228
Mailing Address - Fax:
Practice Address - Street 1:722 PATRICK ST STE 206
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5612
Practice Address - Country:US
Practice Address - Phone:407-548-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100235600Other261111
FL100235600Medicaid