Provider Demographics
NPI:1720375306
Name:ALEJANDRO ELOY DE LA CRUZ MD PA
Entity Type:Organization
Organization Name:ALEJANDRO ELOY DE LA CRUZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:ELOY
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-831-2789
Mailing Address - Street 1:155 SW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1017
Mailing Address - Country:US
Mailing Address - Phone:305-831-2789
Mailing Address - Fax:305-440-4089
Practice Address - Street 1:13214 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1176
Practice Address - Country:US
Practice Address - Phone:305-831-2789
Practice Address - Fax:305-440-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 109588261QH0100X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFJ643ZOtherPTAN
FL004142600Medicaid
FL004142600Medicaid