Healthcare Provider Details

I. General information

NPI: 1891802724
Provider Name (Legal Business Name): JOSEFINO CRUZ AGUILAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15330 HWY 231 431 N
HAZEL GREEN AL
35750
US

IV. Provider business mailing address

15330 HWY 231 431 N
HAZEL GREEN AL
35750
US

V. Phone/Fax

Practice location:
  • Phone: 256-828-3321
  • Fax: 256-828-6696
Mailing address:
  • Phone: 256-828-3321
  • Fax: 256-828-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9646
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: