Provider Demographics
NPI:1073510939
Name:CASARIEGO CRUZ, ISABEL TERESA (MD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:TERESA
Last Name:CASARIEGO CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:TERESA
Other - Last Name:CASARIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-5665
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:1651 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7564
Practice Address - Country:US
Practice Address - Phone:772-398-1800
Practice Address - Fax:772-398-1828
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273198300Medicaid
FL273198300Medicaid
FLU5426YMedicare PIN