Basic Information
| Provider Information | |||||||||
| NPI: | 1053628487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | YOHANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 MERCY DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328085646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078753700 | ||||||||
| FaxNumber: | 4075224671 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MERCY DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328085646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078753700 | ||||||||
| FaxNumber: | 4075224671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2010 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.