Provider Demographics
NPI:1124011515
Name:CRUZ, GILBERTO MELCHOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:MELCHOR
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 1:4160 W 16TH AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5853
Mailing Address - Country:US
Mailing Address - Phone:305-819-4432
Mailing Address - Fax:305-819-4127
Practice Address - Street 1:4160 W 16TH AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:305-819-4432
Practice Address - Fax:305-819-4127
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00615142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL161304OtherSTAYWELL
FL1016688OtherWELL CARE
FL10166888OtherCARE PLUS
FL206582OtherAVMED
FLP00080OtherDOCTOR CARE
FL2507987OtherCIGNA
FL000L6OtherPREFERRED CARE PARTNERS
FL026753OtherNEIGHBORHOOD HEALTH PLAN
14848OtherBLUE CROSS BLUE SHIELD
FL210349OtherAMERIGROUP
FL1016688OtherWELL CARE
FL2507987OtherCIGNA