Basic Information
| Provider Information | |||||||||
| NPI: | 1639717317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ GARCIA | ||||||||
| FirstName: | AUGUSTO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5605 NW 82ND AVE | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331664000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056855688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1521 NW 54TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331423807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865940000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2019 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN1241 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.