Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 284484350 | PR |
NPI | 1487076444 |
---|---|
Provider Name | Mr. Gustavo Cruz |
First Address | Hollywood, FL 33020-6418 |
Second Address | Hollywood, FL 33020-6418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 10/01/2014 |