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General NPI Number Information
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NPI Number | 1629372198
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Entity Type | Organization
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Legal Business Name | RAFAEL CRUZ MD FAMILY PRACTICE LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 204 STATE RD
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City | LEHIGHTON
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State | PA
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Zip | 18235-2827
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Country | US
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Telephone | 702-525-3441
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Fax | 484-534-3594
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Provider Business Mailing Address
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Address Line | 204 STATE RD
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City | LEHIGHTON
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State | PA
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Zip | 18235-2827
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Country | US
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Telephone | 702-525-3441
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Fax | 484-534-3594
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Authorized Official
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Title or Position | DOCTOR OF MEDICINE
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Name | RAFAEL CRUZ
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Credential | M.D.
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Telephone | 702-525-3441
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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 | MD073155L
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License Number State | PA
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