Provider Demographics
NPI:1053492652
Name:CRUZ, GUADALUPE A
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5530
Mailing Address - Country:US
Mailing Address - Phone:786-423-4580
Mailing Address - Fax:305-594-2871
Practice Address - Street 1:6850 CORAL WAY
Practice Address - Street 2:SUITE #204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1758
Practice Address - Country:US
Practice Address - Phone:786-773-2558
Practice Address - Fax:305-728-0526
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL803092471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80309OtherRDMS, AB