Provider Demographics
NPI:1114107760
Name:JOSE A CRUZ JR MD PA
Entity Type:Organization
Organization Name:JOSE A CRUZ JR MD PA
Other - Org Name:JOSE A CRUZ JR MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-532-7455
Mailing Address - Street 1:1210 WASHINGTON AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4632
Mailing Address - Country:US
Mailing Address - Phone:305-532-7455
Mailing Address - Fax:305-532-7457
Practice Address - Street 1:1210 WASHINGTON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4632
Practice Address - Country:US
Practice Address - Phone:305-532-7455
Practice Address - Fax:305-532-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6312Medicare PIN