Individual
DIANA XIMENA CRUZ MACTAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 N CONGRESS AVE, LAKE PARK, FL 33403-3802
(561) 352-2381
Mailing address
500 N CONGRESS AVE, LAKE PARK, FL 33403-3802
(561) 352-2381
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS56388
FL
Other
Enumeration date
07/03/2017
Last updated
05/17/2022
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