Provider Demographics
NPI:1720091838
Name:CRUZ, MARIA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:22 WALNUT ST
Mailing Address - Street 2:LAUREL HEALTH CENTER ADMINISTRATION ATTN:MARIA SMITH
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1526
Mailing Address - Country:US
Mailing Address - Phone:570-723-0621
Mailing Address - Fax:570-724-1197
Practice Address - Street 1:40 W WELLSBORO ST
Practice Address - Street 2:MANSFIELD LAUREL HEALTH CENTER
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1411
Practice Address - Country:US
Practice Address - Phone:570-662-2002
Practice Address - Fax:570-662-2025
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030071E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
435285FEMMedicare ID - Type Unspecified
C34110Medicare UPIN