Provider Demographics
NPI:1366628109
Name:CRUZ, CHERYL GALO (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:GALO
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 1:2927 N 7TH AVE
Mailing Address - Street 2:PEPPERTREE - FAMILY MEDICINE #3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4102
Mailing Address - Country:US
Mailing Address - Phone:602-406-3153
Mailing Address - Fax:602-406-4122
Practice Address - Street 1:2927 N 7TH AVE
Practice Address - Street 2:PEPPERTREE - FAMILY MEDICINE #3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4102
Practice Address - Country:US
Practice Address - Phone:602-406-3153
Practice Address - Fax:602-406-4122
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ80778OtherTRAINING PERMIT