MEDICARE: TEENA DCRUZ

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	207Q00000X	Family Medicine Physician	35.138303	OH

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	:	1811492721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEENA DCRUZ

Provider Business Mailing Address
First Line	:	4100 HORIZONS DR STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-5280
Country	:	US
Telephone Number	:	614-457-1793
Fax Number	:	614-457-0704

Provider Business Practice Location Address
First Line	:	4100 HORIZONS DR STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-5280
Country	:	US
Telephone Number	:	614-457-1793
Fax Number	:	614-457-0704

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

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	10/10/2023

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Directions to “ TEENA DCRUZ ” Practice Location

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