Basic Information
| Provider Information | |||||||||
| NPI: | 1154697258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ DE LA CRUZ | ||||||||
| FirstName: | BLAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10393 SW 88TH ST APT U2 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331761645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055420139 | ||||||||
| FaxNumber: | 8663424373 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 DEL PRADO BLVD S | ||||||||
| Address2: | |||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339902668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394243123 | ||||||||
| FaxNumber: | 2394244041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2012 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME122750 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME122750 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.