1609163153 NPI number — DR. JAIRO B CRUZ JR. DPM

Table of content: DR. JAIRO B CRUZ JR. DPM (NPI 1609163153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609163153 NPI number — DR. JAIRO B CRUZ JR. DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
JAIRO
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DPM
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:
1609163153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38192 MEDICAL CENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEPHYRHILLS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33540-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-782-3233
Provider Business Mailing Address Fax Number:
813-502-5904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38192 MEDICAL CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33540-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-782-3233
Provider Business Practice Location Address Fax Number:
813-502-5904
Provider Enumeration Date:
07/06/2011

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: 213ES0103X , with the licence number:  PO3671 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO3671 , 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: 114053700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO2398421 . This is a "RR MCARE INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PO3671 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1326058249 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14X4T . This is a "BCBS INDIV ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L2158 . This is a "MEDICARE PTAN IND" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L2158 . This is a "MEDICARE INDIVDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5157370001 . This is a "NSC DME PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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