Provider Demographics
NPI:1629372198
Name:RAFAEL CRUZ MD FAMILY PRACTICE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:RAFAEL CRUZ MD FAMILY PRACTICE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-525-3441
Mailing Address - Street 1:204 STATE RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2827
Mailing Address - Country:US
Mailing Address - Phone:702-525-3441
Mailing Address - Fax:484-534-3594
Practice Address - Street 1:204 STATE RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2827
Practice Address - Country:US
Practice Address - Phone:702-525-3441
Practice Address - Fax:484-534-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073155L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty