Provider Demographics
NPI:1518151240
Name:CRUZ, ROGELIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:A
Last Name:CRUZ
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 1:19011 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8914
Mailing Address - Country:US
Mailing Address - Phone:814-664-4725
Mailing Address - Fax:
Practice Address - Street 1:19011 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8914
Practice Address - Country:US
Practice Address - Phone:814-664-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029924L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine