Basic Information
| Provider Information | |||||||||
| NPI: | 1063790996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | MONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 BLUE LAGOON DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331262079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053986100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 NW 42ND AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331265473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056437800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.