Healthcare Provider Details

I. General information

NPI: 1972865640
Provider Name (Legal Business Name): WILHELMINA M. CRUZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD CCU SECOND FLOOR
LANHAM MD
20706-3574
US

IV. Provider business mailing address

10421 MOTOR CITY DR
BETHESDA MD
20827-7604
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8118
  • Fax:
Mailing address:
  • Phone: 301-552-5693
  • Fax: 301-530-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD20633
License Number StateMD

VIII. Authorized Official

Name: DR. WILHELMINA M CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-222-7175