Provider Demographics
NPI:1205221942
Name:CARLOS A. CRUZ, MD, PC
Entity Type:Organization
Organization Name:CARLOS A. CRUZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-434-1096
Mailing Address - Street 1:1707 OSAGE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2611
Mailing Address - Country:US
Mailing Address - Phone:703-824-0970
Mailing Address - Fax:703-824-0972
Practice Address - Street 1:1707 OSAGE ST STE 303
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2611
Practice Address - Country:US
Practice Address - Phone:703-824-0970
Practice Address - Fax:703-824-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty