=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982604674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORNA RUBIANO CRUZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 11/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 MEMORIAL MEDICAL CT STE 1
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-295-3492
-----------------------------------------------------
Fax | 864-295-4817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 MEMORIAL MEDICAL CT STE 1
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-295-3492
-----------------------------------------------------
Fax | 864-295-4817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 83661
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 4301099806
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207ZN0500X
-----------------------------------------------------
Taxonomy Name | Neuropathology Physician
-----------------------------------------------------
License Number | 83661
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 22463
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | MD422756
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207ZN0500X
-----------------------------------------------------
Taxonomy Name | Neuropathology Physician
-----------------------------------------------------
License Number | 22463
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207ZN0500X
-----------------------------------------------------
Taxonomy Name | Neuropathology Physician
-----------------------------------------------------
License Number | MD422756
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 207ZN0500X
-----------------------------------------------------
Taxonomy Name | Neuropathology Physician
-----------------------------------------------------
License Number | 4301099806
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 22463
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | MD422756
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 4301099806
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 83661
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------