Healthcare Provider Details

I. General information

NPI: 1497859755
Provider Name (Legal Business Name): CARMINA CARGO CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 COLONIAL COMMONS CT SUITE 231
LANCASTER SC
29720-2200
US

IV. Provider business mailing address

1228 COLONIAL COMMONS CT SUITE 231
LANCASTER SC
29720-2200
US

V. Phone/Fax

Practice location:
  • Phone: 803-289-5437
  • Fax: 803-289-5440
Mailing address:
  • Phone: 803-289-5437
  • Fax: 803-289-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20230
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: