1659514263 NPI number — CHRISTIAN XAVIER CRUZ PICO M.D.

Table of content: IAN PAUL MCDONALD (NPI 1851013627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659514263 NPI number — CHRISTIAN XAVIER CRUZ PICO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ PICO
Provider First Name:
CHRISTIAN
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1659514263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17416 BROOKSIDE TRACE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-660-6150
Provider Business Mailing Address Fax Number:
813-660-6631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17416 BROOKSIDE TRACE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-660-6150
Provider Business Practice Location Address Fax Number:
813-660-6631
Provider Enumeration Date:
04/13/2009

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:  ME165474 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: MD473302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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