Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | 0-1910652 | FL |
NPI | 1114418746 |
---|---|
Provider Name | Ronald Cruz |
First Address | Lehigh Acres, FL 33971-6440 |
Second Address | Lehigh Acres, FL 33971-6440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023524800 | (05) | FL |