Provider Demographics
NPI:1669660148
Name:CRUZ-FAGEL, LOURDES L (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:L
Last Name:CRUZ-FAGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:C
Other - Last Name:FAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-832-1560
Mailing Address - Fax:302-832-7450
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-832-1560
Practice Address - Fax:302-832-7450
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics