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General NPI Number Information
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NPI Number | 1861439606
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Entity Type | Organization
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Legal Business Name | RENE F CRUZ M D P A
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 424 LAKE HOWELL RD
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City | MAITLAND
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State | FL
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Zip | 32751-5907
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Country | US
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Telephone | 407-644-4595
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Fax | 407-790-7752
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Provider Business Mailing Address
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Address Line | 424 LAKE HOWELL RD
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City | MAITLAND
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State | FL
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Zip | 32751-5907
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Country | US
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Telephone | 407-644-4595
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Fax | 407-790-7752
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RENE FULGENCIO CRUZ
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Credential | MD
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Telephone | 407-644-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0068986
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License Number State | FL
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