Provider Demographics
NPI:1326894809
Name:CRUZ ALAMO, HECTOR EDGARDO
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:EDGARDO
Last Name:CRUZ ALAMO
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 1:21 N WOODFORD ST # 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4531
Mailing Address - Country:US
Mailing Address - Phone:774-417-0557
Mailing Address - Fax:
Practice Address - Street 1:21 N WOODFORD ST # 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4531
Practice Address - Country:US
Practice Address - Phone:774-417-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty