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General NPI Number Information
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NPI Number | 1023089935
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Entity Type | Individual
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Provider Name | JOSE A CRUZ PA
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | JTF-GTMO 525TH MP BN
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City | GUANTANAMO BAY
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State | CUBA
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Zip | APO AE 09360
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Country | CU
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Telephone | 18004648107
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Fax |
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Provider Business Mailing Address
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Address Line | 5435 GINGER COVE DR APT F
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City | TAMPA
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State | FL
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Zip | 33634-1711
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Country | US
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Telephone | 813-889-0910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1037467
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License Number State |
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