Healthcare Provider Details

I. General information

NPI: 1235298027
Provider Name (Legal Business Name): STELLA MARIE CRUZ CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 LT MICHAEL CLEARY DR
DALLAS PA
18612-1649
US

IV. Provider business mailing address

608 CASSANDRA DR
CRANBERRY TWP PA
16066-6926
US

V. Phone/Fax

Practice location:
  • Phone: 570-675-2000
  • Fax: 570-675-1806
Mailing address:
  • Phone: 724-742-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD429903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: