MEDICARE: MERCEDEZ CEAIR CRUZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	ME143817	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518499912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDEZ CEAIR CRUZ MD

Provider Business Mailing Address
First Line	:	18600 FERNVIEW ST STE 102
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-6212
Country	:	US
Telephone Number	:	813-692-8033
Fax Number	:	813-605-6185

Provider Business Practice Location Address
First Line	:	18600 FERNVIEW ST STE 102
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-6212
Country	:	US
Telephone Number	:	813-692-8033
Fax Number	:	813-605-6185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	03/14/2022

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