Provider Demographics
NPI:1851430870
Name:CRUZ, ELDIE LEVI (MD)
Entity Type:Individual
Prefix:
First Name:ELDIE
Middle Name:LEVI
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 DR MARTIN LUTHER KING NE
Mailing Address - Street 2:301
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2567
Mailing Address - Country:US
Mailing Address - Phone:505-727-7090
Mailing Address - Fax:505-727-7099
Practice Address - Street 1:715 DR MARTIN LUTHER KING NE
Practice Address - Street 2:301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2567
Practice Address - Country:US
Practice Address - Phone:505-727-7090
Practice Address - Fax:505-727-7099
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60072876208600000X
NMMD2013-0287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69586764Medicaid
NM69586764Medicaid