Healthcare Provider Details

I. General information

NPI: 1285053009
Provider Name (Legal Business Name): KIMBERLY CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY PARKER

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 NE 26TH AVE
POMPANO BEACH FL
33062-3724
US

IV. Provider business mailing address

1221 NE 26TH AVE
POMPANO BEACH FL
33062-3724
US

V. Phone/Fax

Practice location:
  • Phone: 954-994-6633
  • Fax:
Mailing address:
  • Phone: 954-994-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME133989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: