Provider Demographics
NPI:1356216030
Name:CRUZ RODRIGUEZ, LUIS SR
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:CRUZ RODRIGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 CYPRESS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3767
Mailing Address - Country:US
Mailing Address - Phone:813-405-5107
Mailing Address - Fax:813-405-5107
Practice Address - Street 1:8888 CYPRESS MANOR DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3767
Practice Address - Country:US
Practice Address - Phone:813-405-5107
Practice Address - Fax:813-405-5107
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20250128145412170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics