Provider Demographics
NPI:1467483073
Name:DE LA CRUZ MUNOZ, NESTOR F JR (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:F
Last Name:DE LA CRUZ MUNOZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-1288
Mailing Address - Fax:305-856-4301
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-856-4385
Practice Address - Fax:305-856-4301
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG85546Medicare UPIN
FLE1906Medicare ID - Type Unspecified