Provider Demographics
NPI:1790170843
Name:BALTAZAR, GABRIEL CRUZ (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:CRUZ
Last Name:BALTAZAR
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 1:4900 PERRIER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2910
Mailing Address - Country:US
Mailing Address - Phone:214-418-6377
Mailing Address - Fax:
Practice Address - Street 1:185 E 85TH ST APT 26J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2151
Practice Address - Country:US
Practice Address - Phone:214-418-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2968541207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology