Provider Demographics
NPI:1609034362
Name:CRUZ, RAYMOND IBARRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:IBARRA
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 1:2400 LEE HWY N
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-2326
Mailing Address - Country:US
Mailing Address - Phone:540-994-8580
Mailing Address - Fax:540-994-8183
Practice Address - Street 1:2400 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2326
Practice Address - Country:US
Practice Address - Phone:540-994-8580
Practice Address - Fax:540-994-8183
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012387950207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609034362Medicaid
VA1609034362Medicaid
VAP01685851Medicare PIN
VAVVL388AMedicare PIN