Provider Demographics
NPI:1184919649
Name:CRUZ, ANTHONY MARC (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MARC
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LANIER CRES
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1360
Mailing Address - Country:US
Mailing Address - Phone:858-539-9810
Mailing Address - Fax:
Practice Address - Street 1:540 LANIER CRES
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-1360
Practice Address - Country:US
Practice Address - Phone:858-539-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program