Provider Demographics
NPI:1548773815
Name:CRUZ, AMNERIS (MA, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:AMNERIS
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:CHAMBERINO
Mailing Address - State:NM
Mailing Address - Zip Code:88027
Mailing Address - Country:US
Mailing Address - Phone:862-247-7094
Mailing Address - Fax:
Practice Address - Street 1:213 N MEDINA AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERINO
Practice Address - State:NM
Practice Address - Zip Code:88027
Practice Address - Country:US
Practice Address - Phone:862-247-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691207Medicaid