Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO3913 | FL |
NPI | 1376938183 |
---|---|
Provider Name | Jasmine Cruz |
First Address | Delray Beach, FL 33445-3978 |
Second Address | Boynton Beach, FL 33437-6155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025110800 | (05) | FL |