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General NPI Number Information
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NPI Number | 1639166044
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Entity Type | Individual
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Provider Name | JUAN ANTONIO CRUZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 20001 SW 127TH AVE
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City | MIAMI
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State | FL
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Zip | 33177-5118
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Country | US
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Telephone | 305-406-2069
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Fax | 786-577-4381
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Provider Business Mailing Address
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Address Line | 6100 BLUE LAGOON DR STE 365
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City | MIAMI
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State | FL
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Zip | 33126-7010
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Country | US
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Telephone | 786-322-7333
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME91723
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License Number State | FL
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