Provider Demographics
NPI:1639717317
Name:CRUZ GARCIA, AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:CRUZ GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4000
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:
Practice Address - Street 1:1521 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3807
Practice Address - Country:US
Practice Address - Phone:786-594-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1241208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice