Provider Demographics
NPI:1043292907
Name:CRUZ, SALVADOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SOUTH UNION
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003
Mailing Address - Country:US
Mailing Address - Phone:719-543-6988
Mailing Address - Fax:719-542-1290
Practice Address - Street 1:128 S-UNION
Practice Address - Street 2:SUITE C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-543-6988
Practice Address - Fax:719-542-1290
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23403103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO076679Medicaid
DB7127OtherRR MEDICARE - GROUP
P00123342OtherRR MEDICARE - IND
P00123342OtherRR MEDICARE - IND
E05466Medicare UPIN
COE05466Medicare UPIN