Healthcare Provider Details

I. General information

NPI: 1568276459
Provider Name (Legal Business Name): RYZE PMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MACDILL AVE
TAMPA FL
33609-3532
US

IV. Provider business mailing address

200 S MACDILL AVE
TAMPA FL
33609-3532
US

V. Phone/Fax

Practice location:
  • Phone: 813-353-1268
  • Fax: 813-353-1269
Mailing address:
  • Phone: 813-353-1268
  • Fax: 813-353-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA E CRUZ
Title or Position: PRESIDENT
Credential: DO
Phone: 813-353-1268