Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003475435 |
---|---|
Provider Name | Mr. Eddy Eloy Quintana Cruz |
First Address | Miami, FL 33177-4969 |
Second Address | Miami, FL 33165-3636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/06/2019 |