=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265452338
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS ALBERTO CRUZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3327 DUKE ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-824-0970
-----------------------------------------------------
Fax | 703-824-0972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6295 TIMARRON COVE LN
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-4076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-278-9340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101233315
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------