Basic Information
| Provider Information | |||||||||
| NPI: | 1861488330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ DIAZ | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 7729 E PINE LAKE LN | ||||||||
| Address2: | |||||||||
| City: | FLORAL CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344363745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527653003 | ||||||||
| FaxNumber: | 3526160915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14659 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | ACN769 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 016745300 | 05 | FL | MEDICAID |