Provider Demographics
NPI:1861763377
Name:CRUZ-VARGAS, MARIA T (COTA)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:T
Last Name:CRUZ-VARGAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8590 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6652
Mailing Address - Country:US
Mailing Address - Phone:954-326-1569
Mailing Address - Fax:
Practice Address - Street 1:8590 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6652
Practice Address - Country:US
Practice Address - Phone:954-326-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9791314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility