Provider Demographics
NPI:1235924218
Name:CRUZ, CHARLES EMMANUEL II
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EMMANUEL
Last Name:CRUZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MILAN DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4303
Mailing Address - Country:US
Mailing Address - Phone:305-713-0443
Mailing Address - Fax:
Practice Address - Street 1:630 MILAN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4303
Practice Address - Country:US
Practice Address - Phone:305-713-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst