Provider Demographics
NPI:1891677936
Name:CRUZ COSIO, HARLEY
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:CRUZ COSIO
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 1:8340 SANDS POINT BLVD APT P101
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3827
Mailing Address - Country:US
Mailing Address - Phone:786-975-5887
Mailing Address - Fax:
Practice Address - Street 1:8340 SANDS POINT BLVD APT P101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3827
Practice Address - Country:US
Practice Address - Phone:786-975-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician