Provider Demographics
NPI:1619263027
Name:CRUZ ITHIER, MAYRA ALEJANDRA (MS, MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:CRUZ ITHIER
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:625 6TH AVE S STE 340
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4619
Mailing Address - Country:US
Mailing Address - Phone:727-767-7903
Mailing Address - Fax:727-767-7905
Practice Address - Street 1:625 6TH AVE S STE 340
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-767-7903
Practice Address - Fax:727-767-7905
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122845207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024967800Medicaid