Provider Demographics
NPI:1205827763
Name:CRUZ, ROGELIO (PA)
Entity Type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-682-7730
Practice Address - Street 1:500 E RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1508
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-926-4352
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323073201Medicaid
TX899N61OtherBCBS TX
TX323073201Medicaid
TX277261YN0EMedicare PIN