Provider Demographics
NPI:1902184906
Name:CRUZ, GABRIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WEST 68 ST
Mailing Address - Street 2:SUITE 127
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4407
Mailing Address - Country:US
Mailing Address - Phone:305-820-0903
Mailing Address - Fax:305-826-3827
Practice Address - Street 1:1800 WEST 68 ST
Practice Address - Street 2:SUITE 127
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4407
Practice Address - Country:US
Practice Address - Phone:305-820-0903
Practice Address - Fax:305-826-3827
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant