Provider Demographics
NPI:1518566520
Name:CRUZ, CHRIS
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 E COMMERCIAL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4216
Mailing Address - Country:US
Mailing Address - Phone:954-904-4780
Mailing Address - Fax:954-990-7056
Practice Address - Street 1:2821 E COMMERCIAL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4216
Practice Address - Country:US
Practice Address - Phone:954-904-4780
Practice Address - Fax:954-990-7056
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies