Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 066584 | NY |
NPI | 1003342403 |
---|---|
Provider Name | Mr. David Cruz |
First Address | Bronx, NY 10452-9128 |
Second Address | Bronx, NY 10452-9128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 04/05/2017 |