Healthcare Provider Details

I. General information

NPI: 1952930406
Provider Name (Legal Business Name): ALEXANDRA MARIA CRUZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST STE 69
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

4190 CITY AVENUE
PHIALDELPHIA PA
19131
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-5465
  • Fax:
Mailing address:
  • Phone:
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS19813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: