1467511816 NPI number — DR. NARLITO V CRUZ M.D.

Table of content: CHRISTINA L. FLAVIN PA-C (NPI 1568405421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467511816 NPI number — DR. NARLITO V CRUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
NARLITO
Provider Middle Name:
V
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:
1467511816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2619 CENTENNIAL BLVD
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-656-7720
Provider Business Mailing Address Fax Number:
850-656-7729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2619 CENTENNIAL BLVD
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-0587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-656-7720
Provider Business Practice Location Address Fax Number:
850-656-7729
Provider Enumeration Date:
12/08/2006

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: 207K00000X , with the licence number:  75761 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207K00000X , with the licence number: 45758 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004211500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00802227A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004211500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com