MEDICARE: MS. DINIA CRUZ M.D.

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	208000000X	Pediatrics Physician	13580	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629062963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DINIA CRUZ M.D.

Provider Business Mailing Address
First Line	:	5180 PARK AVENUE
Second Line	:	SUITE 200
City	:	MEMPHIS
State	:	TN
Zip	:	38119
Country	:	US
Telephone Number	:	901-729-6522
Fax Number	:	901-572-1908

Provider Business Practice Location Address
First Line	:	5735 NANJACK CIRCLE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-729-6522
Fax Number	:	901-572-1908

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/11/2021

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