Provider Demographics
NPI:1023089935
Name:CRUZ, JOSE A (PA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:CRUZ-SAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:5435 GINGER COVE DR
Mailing Address - Street 2:APT F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1711
Mailing Address - Country:US
Mailing Address - Phone:813-889-0910
Mailing Address - Fax:
Practice Address - Street 1:JTF-GTMO
Practice Address - Street 2:525TH MP BN
Practice Address - City:GUANTANAMO BAY
Practice Address - State:CUBA
Practice Address - Zip Code:APO AE 09360
Practice Address - Country:CU
Practice Address - Phone:1800-464-8107
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1037467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical