Physician Compare National (NPI:1629635073)

HEALTHCARE PROVIDER: JOSE MIGUEL DE LA CRUZ LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629635073
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3870820293
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190808000768
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DE LA CRUZ
	Individual professional last name
Provider First Name	JOSE
	Individual professional first name
Provider Middle Name	MIGUEL
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1850 LEE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 122A
	Group Practice or individual's line 2 address
City	WINTER PARK
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	327892104
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y