Provider Demographics
NPI:1023297702
Name:CRUZ-LUNA, SARA ENID (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ENID
Last Name:CRUZ-LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ENID
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1243 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3469
Mailing Address - Country:US
Mailing Address - Phone:727-442-3126
Mailing Address - Fax:727-287-4559
Practice Address - Street 1:1243 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3469
Practice Address - Country:US
Practice Address - Phone:727-442-3126
Practice Address - Fax:727-287-4559
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003954800Medicaid
12169645OtherCAQH
12169645OtherCAQH