Provider Demographics
NPI:1376021642
Name:CRUZ-VENEGAS, PAULINA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:
Last Name:CRUZ-VENEGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1649
Mailing Address - Country:US
Mailing Address - Phone:404-836-0136
Mailing Address - Fax:404-850-8695
Practice Address - Street 1:1325 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1649
Practice Address - Country:US
Practice Address - Phone:404-836-0136
Practice Address - Fax:404-850-8695
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21037208D00000X
GA92449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice