MEDICARE: JOSEPH A. 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	207Q00000X	Family Medicine Physician	A49080	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A49080	OTHER	CA	BLUE CROSS
2	00A490800	OTHER	CA	BLUE SHIELD OF CA PIN

General Provider Information

NPI Number	:	1598769929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A. CRUZ MD

Provider Business Mailing Address
First Line	:	2 JAMES WAY
Second Line	:	SUITE 209
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-7440
Fax Number	:	805-773-7448

Provider Business Practice Location Address
First Line	:	2 JAMES WAY
Second Line	:	SUITE 209
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-7440
Fax Number	:	805-773-7448

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/28/2012

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