MEDICARE: JOSE A CRUZ JR MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME90082	FL

General Provider Information

NPI Number	:	1114107760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE A CRUZ JR MD PA

Provider Business Mailing Address
First Line	:	1210 WASHINGTON AVE
Second Line	:	SUITE 220
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4632
Country	:	US
Telephone Number	:	305-532-7455
Fax Number	:	305-532-7457

Provider Business Practice Location Address
First Line	:	1210 WASHINGTON AVE
Second Line	:	SUITE 220
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4632
Country	:	US
Telephone Number	:	305-532-7455
Fax Number	:	305-532-7457

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KAREN G CRUZ
Credential	:
Telephone Number	:	305-532-7455

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	03/21/2011

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