Basic Information
| Provider Information | |||||||||
| NPI: | 1174020960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUZA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | CARLOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 OAK ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013905 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 890 OAK ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD209903 | OR | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.