Provider Demographics
NPI:1568649606
Name:CRUZ, LUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:655 HARMON LOOP RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:671-633-4447
Mailing Address - Fax:671-633-4452
Practice Address - Street 1:655 HARMON LOOP RD STE 108
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-633-4447
Practice Address - Fax:671-633-4452
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GUM1635207Q00000X, 207QS0010X
AZ80816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine