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General NPI Number Information
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NPI Number | 1104271725
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Entity Type | Individual
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Provider Name | LAURA MARIE HERNANDEZ CRUZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 2701 STATE ROAD 66
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City | SEBRING
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State | FL
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Zip | 33875-6265
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Country | US
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Telephone | 786-948-6461
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 STATE ROAD 66
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City | SEBRING
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State | FL
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Zip | 33875-6265
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Country | US
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Telephone | 786-948-6461
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101275453
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19319
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME157991
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License Number State | FL
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