Healthcare Provider Details

I. General information

NPI: 1982533501
Provider Name (Legal Business Name): GINA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11933 FROST ASTER DR
RIVERVIEW FL
33579-4107
US

IV. Provider business mailing address

11933 FROST ASTER DR
RIVERVIEW FL
33579-4107
US

V. Phone/Fax

Practice location:
  • Phone: 973-336-9636
  • Fax:
Mailing address:
  • Phone: 973-336-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1455201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: