Provider Demographics
NPI:1467400408
Name:LORA CRUZ, LIVINO A (MD)
Entity Type:Individual
Prefix:MR
First Name:LIVINO
Middle Name:A
Last Name:LORA CRUZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:2511 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6310
Practice Address - Country:US
Practice Address - Phone:813-252-9240
Practice Address - Fax:386-668-6897
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLACN874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL6353382OtherDEA
PRG41104Medicare UPIN