Basic Information
| Provider Information | |||||||||
| NPI: | 1851430870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | ELDIE | ||||||||
| MiddleName: | LEVI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 DR MARTIN LUTHER KING NE | ||||||||
| Address2: | 301 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277090 | ||||||||
| FaxNumber: | 5057277099 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 DR MARTIN LUTHER KING NE | ||||||||
| Address2: | 301 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277090 | ||||||||
| FaxNumber: | 5057277099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD60072876 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD2013-0287 | NM | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 69586764 | 05 | NM | MEDICAID |