Provider Demographics
NPI:1982150751
Name:CRUZ, AMADOR J (PA)
Entity Type:Individual
Prefix:
First Name:AMADOR
Middle Name:J
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5416
Mailing Address - Fax:210-678-4142
Practice Address - Street 1:150 E SONTERRA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4098
Practice Address - Country:US
Practice Address - Phone:210-593-1420
Practice Address - Fax:210-593-1423
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
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Provider Licenses
StateLicense IDTaxonomies
TXPA10733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA10733OtherSTATE MEDICAL LICENSE