Provider Demographics
NPI:1558037515
Name:CRUZ, SAGRARIO R
Entity type:Individual
Prefix:
First Name:SAGRARIO
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 LALIQUE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5121
Mailing Address - Country:US
Mailing Address - Phone:407-473-8581
Mailing Address - Fax:
Practice Address - Street 1:1737 LALIQUE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5121
Practice Address - Country:US
Practice Address - Phone:407-473-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker