Healthcare Provider Details

I. General information

NPI: 1780697102
Provider Name (Legal Business Name): LUIS CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 PALM AVE
HIALEAH FL
33012-5427
US

IV. Provider business mailing address

3233 PALM AVE 4TH FLOOR
HIALEAH FL
33012-5427
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-0590
  • Fax: 305-643-6326
Mailing address:
  • Phone: 305-642-0590
  • Fax: 305-643-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME44657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: