Healthcare Provider Details

I. General information

NPI: 1023089935
Provider Name (Legal Business Name): JOSE A CRUZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOSE A CRUZ-SAEZ PA

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JTF-GTMO 525TH MP BN
GUANTANAMO BAY CUBA
APO AE 09360
CU

IV. Provider business mailing address

5435 GINGER COVE DR APT F
TAMPA FL
33634-1711
US

V. Phone/Fax

Practice location:
  • Phone: 18004648107
  • Fax:
Mailing address:
  • Phone: 813-889-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1037467
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: