Healthcare Provider Details

I. General information

NPI: 1205221942
Provider Name (Legal Business Name): CARLOS A. CRUZ, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 OSAGE ST STE 303
ALEXANDRIA VA
22302-2611
US

IV. Provider business mailing address

1707 OSAGE ST STE 303
ALEXANDRIA VA
22302-2611
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-0970
  • Fax: 703-824-0972
Mailing address:
  • Phone: 703-824-0970
  • Fax: 703-824-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS ALBERTO CRUZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 301-434-1096