Healthcare Provider Details

I. General information

NPI: 1609163153
Provider Name (Legal Business Name): JAIRO B CRUZ JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38192 MEDICAL CENTER AVE
ZEPHYRHILLS FL
33540-1380
US

IV. Provider business mailing address

38192 MEDICAL CENTER AVE
ZEPHYRHILLS FL
33540-1380
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-3233
  • Fax: 813-502-5904
Mailing address:
  • Phone: 813-782-3233
  • Fax: 813-502-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3671
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: