Provider Demographics
NPI:1285231910
Name:DIAZ CRUZ, GABRIEL JOSE
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOSE
Last Name:DIAZ CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FRONT ST STE 280
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2891
Mailing Address - Country:US
Mailing Address - Phone:215-860-0100
Mailing Address - Fax:
Practice Address - Street 1:100 FRONT ST STE 280
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2891
Practice Address - Country:US
Practice Address - Phone:215-860-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist