1427287465 NPI number — JOSE MARIA ROBERTO CRUZ JACINTO MD

Table of content: JOSE MARIA ROBERTO CRUZ JACINTO MD (NPI 1427287465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427287465 NPI number — JOSE MARIA ROBERTO CRUZ JACINTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACINTO
Provider First Name:
JOSE MARIA ROBERTO
Provider Middle Name:
CRUZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427287465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 BRYAN DR STE 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74701-2158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-931-9400
Provider Business Mailing Address Fax Number:
580-931-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 DEKALB AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-250-6923
Provider Business Practice Location Address Fax Number:
718-250-6080
Provider Enumeration Date:
07/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  003410 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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