Provider Demographics
NPI:1871178079
Name:CRUZ GORGOY, YULIET
Entity type:Individual
Prefix:
First Name:YULIET
Middle Name:
Last Name:CRUZ GORGOY
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 1:2200 TAYLOR ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4456
Mailing Address - Country:US
Mailing Address - Phone:786-458-2028
Mailing Address - Fax:
Practice Address - Street 1:2200 TAYLOR ST APT 305
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4456
Practice Address - Country:US
Practice Address - Phone:786-458-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-127110106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician