Provider Demographics
NPI:1790983203
Name:FELIZ DE LA CRUZ, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:FELIZ DE LA CRUZ
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 1:3010 E 138TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3904
Mailing Address - Country:US
Mailing Address - Phone:813-975-2800
Mailing Address - Fax:813-977-7631
Practice Address - Street 1:3010 E 138TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3904
Practice Address - Country:US
Practice Address - Phone:813-975-2800
Practice Address - Fax:813-977-7631
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99288207R00000X, 207RC0000X
FLME 99288207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000783600Medicaid
FL1450YOtherBLUE CROSS/BLUE SHIELD
FL000783600Medicaid