Provider Demographics
NPI:1225008105
Name:CRUZ, SYLVIA S (DO)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:S
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SOUTH LOUISIANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-267-5559
Mailing Address - Fax:304-267-5557
Practice Address - Street 1:215 SOUTH LOUISIANA AVENUE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-5559
Practice Address - Fax:304-267-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1634207V00000X
MI5101012085207V00000X
VA0102050038207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51D0952997OtherCLIA
WV0093819000Medicaid
VA6213251OtherMEDICAID
51D0952997OtherCLIA
G74392Medicare UPIN