Healthcare Provider Details

I. General information

NPI: 1427287465
Provider Name (Legal Business Name): JOSE MARIA ROBERTO CRUZ JACINTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE.
BROOKLYN NY
11201
US

IV. Provider business mailing address

1400 BRYAN DR STE 307
DURANT OK
74701-2158
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6923
  • Fax: 718-250-6080
Mailing address:
  • Phone: 580-931-9400
  • Fax: 580-931-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number003410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: