MEDICARE: OSVALDO GARCIA DE LA CRUZ

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	2085U0001X	Diagnostic Ultrasound Physician	00051887	FL

General Provider Information

NPI Number	:	1245984640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO GARCIA DE LA CRUZ

Provider Business Mailing Address
First Line	:	4721 SW 142ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 SW 142ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4324
Country	:	US
Telephone Number	:	786-326-2404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2022
Last Update Date	:	02/05/2022

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