Provider Demographics
NPI:1821106139
Name:DESIREE ORTIZ-CRUZ, MD, PC
Entity Type:Organization
Organization Name:DESIREE ORTIZ-CRUZ, MD, PC
Other - Org Name:DESIREE ORTIZ-CRUZ
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-248-1004
Mailing Address - Street 1:P.O. BOX 6570
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506
Mailing Address - Country:US
Mailing Address - Phone:580-248-1004
Mailing Address - Fax:580-248-1108
Practice Address - Street 1:2701 SW A AVENUE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73506
Practice Address - Country:US
Practice Address - Phone:580-248-1004
Practice Address - Fax:580-248-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522153Medicare UPIN
OK900522153Medicare PIN