Provider Demographics
NPI:1609688357
Name:CRUZ PASTRANA, LUIS A
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:CRUZ PASTRANA
Suffix:
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 1:1809 JACKSON ST UNIT 521
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5659
Mailing Address - Country:US
Mailing Address - Phone:786-718-0427
Mailing Address - Fax:
Practice Address - Street 1:1809 JACKSON ST UNIT 521
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5659
Practice Address - Country:US
Practice Address - Phone:786-718-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician