Provider Demographics
NPI:1457627358
Name:CRUZ-ORTIZ, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CRUZ-ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5951 JEFFERSON ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3450
Mailing Address - Country:US
Mailing Address - Phone:786-200-8851
Mailing Address - Fax:
Practice Address - Street 1:5951 JEFFERSON ST NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3450
Practice Address - Country:US
Practice Address - Phone:505-247-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-16532084P0800X
FLME1188832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry