MEDICARE: ASTINI SANJOTO DE LA 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	207Q00000X	Family Medicine Physician	R9426	TX

General Provider Information

NPI Number	:	1972038107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASTINI SANJOTO DE LA CRUZ M.D

Provider Business Mailing Address
First Line	:	5749 SAN FELIPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3101
Country	:	US
Telephone Number	:	281-783-8162
Fax Number	:	713-439-7995

Provider Business Practice Location Address
First Line	:	15882 CHAMPION FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7141
Country	:	US
Telephone Number	:	281-783-8162
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	12/31/2021

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