1336320787 NPI number — DR. GLOYDIAN CRUZ-GOMEZ M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336320787 NPI number — DR. GLOYDIAN CRUZ-GOMEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ-GOMEZ
Provider First Name:
GLOYDIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUZ
Provider Other First Name:
GLOYDIAN
Provider Other Middle Name:
GOMEZ
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336320787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22511
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:
33622-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-309-7108
Provider Business Mailing Address Fax Number:
727-748-4739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 E 8TH AVE STE A200
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:
33605-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-748-4742
Provider Business Practice Location Address Fax Number:
727-748-4739
Provider Enumeration Date:
11/14/2007

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: 208100000X , with the licence number:  ME110430 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14F22 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7722166 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2338967 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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