Provider Demographics
NPI:1609060565
Name:CRUZ MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:CRUZ MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-7845
Mailing Address - Street 1:857 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4319
Mailing Address - Country:US
Mailing Address - Phone:305-863-7845
Mailing Address - Fax:305-863-7865
Practice Address - Street 1:857 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4319
Practice Address - Country:US
Practice Address - Phone:305-863-7845
Practice Address - Fax:305-863-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0839640001Medicare NSC