Basic Information
| Provider Information | |||||||||
| NPI: | 1003408873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-DIAZ | ||||||||
| FirstName: | ANNET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17900 NW 86TH AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330152507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862807703 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4175 W 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058250300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2021 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW17820 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.