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General NPI Number Information
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NPI Number | 1073791208
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Entity Type | Organization
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Legal Business Name | MIAMI VALLEY UROLOGY
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 3533 SOUTHERN BLVD STE 3450
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City | KETTERING
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State | OH
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Zip | 45429-1264
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Country | US
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Telephone | 937-293-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 3533 SOUTHERN BLVD STE 3450
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City | KETTERING
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State | OH
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Zip | 45429-1264
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Country | US
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Telephone | 937-293-0008
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. RAFAEL CRUZ
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Credential | M.D.
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Telephone | 937-293-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35034095C
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License Number State | OH
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