1356337802 NPI number — DR. MAURICE CRUZ M.D.

Table of content: DR. MAURICE CRUZ M.D. (NPI 1356337802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356337802 NPI number — DR. MAURICE CRUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
MAURICE
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1356337802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5955 PONCE DE LEON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-2423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-661-1515
Provider Business Mailing Address Fax Number:
305-662-3723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 45TH ST STE 202-6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANGONIA PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-558-1212
Provider Business Practice Location Address Fax Number:
561-558-1292
Provider Enumeration Date:
09/21/2005

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: 2080P0214X , with the licence number:  0055895 , 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: 14293 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14293 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2053218 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P211917 . This is a "OXFORD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 203191 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 209935 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 370197200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23942 . This is a "SOUTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 994755 . This is a "NEIGHBORHOOD HEALTH PARTN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15168 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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