Provider Demographics
NPI:1841261880
Name:CRUZ, ROSITA RAQUIDAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROSITA
Middle Name:RAQUIDAN
Last Name:CRUZ
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 1:801 WASHINGTON BOULEVARD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2321
Mailing Address - Country:US
Mailing Address - Phone:410-685-5555
Mailing Address - Fax:410-685-0320
Practice Address - Street 1:801 WASHINGTON BOULEVARD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2321
Practice Address - Country:US
Practice Address - Phone:410-685-5555
Practice Address - Fax:410-685-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030355174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420081100Medicaid
MDD74592Medicare UPIN
MD420081100Medicaid