Provider Demographics
NPI:1629452719
Name:CRUZ CHERY, PAOLA NINOSKA (MD)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:NINOSKA
Last Name:CRUZ CHERY
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 1:360 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3335
Mailing Address - Country:US
Mailing Address - Phone:407-788-8200
Mailing Address - Fax:407-788-3746
Practice Address - Street 1:360 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3335
Practice Address - Country:US
Practice Address - Phone:407-788-8200
Practice Address - Fax:407-788-3746
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61684207R00000X
FLME144239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME144239OtherSTATE LICENSE
FLMG531OtherMEDICARE
FL106110400Medicaid