=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609163153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIRO B CRUZ JR. DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 01/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38192 MEDICAL CENTER AVE
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33540-1380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-782-3233
-----------------------------------------------------
Fax | 813-502-5904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38192 MEDICAL CENTER AVE
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33540-1380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-782-3233
-----------------------------------------------------
Fax | 813-502-5904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO3671
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO3671
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------