Provider Demographics
NPI:1366162414
Name:CRUZ, HAREN ALYAH LOTO
Entity type:Individual
Prefix:
First Name:HAREN ALYAH
Middle Name:LOTO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 30TH AVENUE
Mailing Address - Street 2:2F
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:424-457-9929
Mailing Address - Fax:
Practice Address - Street 1:548 HOWARD AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233
Practice Address - Country:US
Practice Address - Phone:929-522-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046552-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist