Provider Demographics
NPI:1881636652
Name:CRUZ, DOMINIC CAMACHO (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:CAMACHO
Last Name: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 1:855 WEST PEACHTREE ST NW
Mailing Address - Street 2:APT 1212
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1171
Mailing Address - Country:US
Mailing Address - Phone:404-872-5058
Mailing Address - Fax:
Practice Address - Street 1:855 W PEACHTREE ST NW
Practice Address - Street 2:APT 1212
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1167
Practice Address - Country:US
Practice Address - Phone:404-872-5058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine