Provider Demographics
NPI:1629062963
Name:CRUZ, DINIA (MD)
Entity Type:Individual
Prefix:MS
First Name:DINIA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 PARK AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-729-6522
Mailing Address - Fax:901-572-1908
Practice Address - Street 1:5735 NANJACK CIRCLE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2058
Practice Address - Country:US
Practice Address - Phone:901-729-6522
Practice Address - Fax:901-572-1908
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3845444Medicaid
TN3845446Medicare ID - Type Unspecified
TN3845444Medicaid