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NPI Code Detail

MEDICARE: CRUZ AZUL OF WPB

MEDICARE: CRUZ AZUL OF WPB
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
1208D00000XGeneral Practice PhysicianLE91892FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11891785994OTHERFLCOMERCIAL INSURANCES PPO HMO

General Provider Information

NPI Number : 1811278245
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRUZ AZUL OF WPB
Provider Business Mailing Address
First Line : 6294 18TH ST S
Second Line :
City : WEST PALM BCH
State : FL
Zip : 33415-5419
Country : US
Telephone Number : 561-201-4016
Fax Number :
Provider Business Practice Location Address
First Line : 6294 18TH ST S
Second Line :
City : WEST PALM BCH
State : FL
Zip : 33415-5419
Country : US
Telephone Number : 561-201-4016
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DACHA CRUZ
Credential :
Telephone Number : 561-201-4016
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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Directions to “CRUZ AZUL OF WPB ” Practice Location

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