Healthcare Provider Details

I. General information

NPI: 1922635564
Provider Name (Legal Business Name): LOUIS JAMAL CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3912
US

IV. Provider business mailing address

12934 WALKING HORSE
HELOTES TX
78023-4570
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-4000
  • Fax:
Mailing address:
  • Phone: 512-961-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU5942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: