Provider Demographics
NPI:1508845678
Name:CRUZ-ZENO, EDWIN RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:RODOLFO
Last Name:CRUZ-ZENO
Suffix:
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:4651 SHERIDAN ST STE 150
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3443
Practice Address - Country:US
Practice Address - Phone:954-276-1600
Practice Address - Fax:954-893-6244
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1348082081P0010X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024907100Medicaid
CT001359935Medicaid
CT250000218Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER