MEDICARE: CRUZ MEDICAL SERVICES LLC

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

General Provider Information

NPI Number	:	1396117289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUZ MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1725 E HIGHWAY 50
Second Line	:	SUITE A
City	:	CLERMONT
State	:	FL
Zip	:	34711-5188
Country	:	US
Telephone Number	:	352-708-6097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 E HIGHWAY 50
Second Line	:	SUITE A
City	:	CLERMONT
State	:	FL
Zip	:	34711-5188
Country	:	US
Telephone Number	:	352-708-6097
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. EDGAR CRUZ
Credential	:	MD
Telephone Number	:	352-708-6097

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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