Healthcare Provider Details

I. General information

NPI: 1467400408
Provider Name (Legal Business Name): LIVINO A. LORA CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/07/2023
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W VIRGINIA AVE
TAMPA FL
33607-6310
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 813-252-9240
  • Fax: 386-668-6897
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberACN874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: