Provider Demographics
NPI:1306038864
Name:CRUZ, LILLIAN I (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:I
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6097 JASMINE VINE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7117
Mailing Address - Country:US
Mailing Address - Phone:386-690-1880
Mailing Address - Fax:
Practice Address - Street 1:N14 AVE AA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3130
Practice Address - Country:US
Practice Address - Phone:787-292-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9409208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082519OtherMEDICARE PROVIDER NUMBER