Provider Demographics
NPI:1093995060
Name:CESAR D CRUZ MD LLC
Entity Type:Organization
Organization Name:CESAR D CRUZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:813-237-1106
Mailing Address - Street 1:701 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:STE 6
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3100
Mailing Address - Country:US
Mailing Address - Phone:813-237-1106
Mailing Address - Fax:813-238-5619
Practice Address - Street 1:701 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE 6
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3100
Practice Address - Country:US
Practice Address - Phone:813-237-1106
Practice Address - Fax:813-238-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9750Medicare PIN