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General NPI Number Information
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NPI Number | 1376021642
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Entity Type | Individual
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Provider Name | PAULINA CRUZ-VENEGAS MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 1325 RALPH DAVID ABERNATHY BLVD SW
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City | ATLANTA
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State | GA
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Zip | 30310-1649
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Country | US
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Telephone | 404-836-0136
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Fax | 404-850-8695
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Provider Business Mailing Address
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Address Line | 1325 RALPH DAVID ABERNATHY BLVD SW
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City | ATLANTA
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State | GA
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Zip | 30310-1649
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Country | US
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Telephone | 404-836-0136
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Fax | 404-850-8695
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 21037
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 92449
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License Number State | GA
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