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General NPI Number Information
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NPI Number | 1720375306
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Entity Type | Organization
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Legal Business Name | ALEJANDRO ELOY DE LA CRUZ MD PA
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 13214 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33184-1176
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Country | US
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Telephone | 305-831-2789
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Fax | 305-440-4089
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Provider Business Mailing Address
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Address Line | 155 SW 136TH AVE
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City | MIAMI
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State | FL
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Zip | 33184-1017
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Country | US
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Telephone | 305-831-2789
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Fax | 305-440-4089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEJANDRO ELOY DE LA CRUZ
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Credential | MD
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Telephone | 305-831-2789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME 109588
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME 109588
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License Number State | FL
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