Basic Information
| Provider Information | |||||||||
| NPI: | 1013027333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | ORLANDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1465 | ||||||||
| Address2: | |||||||||
| City: | SABANA SECA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009521465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 3142220614 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 LUIS MUNOZ MARIN AVENUE | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 3142220614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 17784 | PR | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 110831 | 01 | MO | BLUE CROSS-BLUE SHIELD | OTHER | 290274 | 01 | MO | HEALTHLINK | OTHER | 5859116 | 01 | MO | AETNA | OTHER | 208493601 | 05 | MO | MEDICAID | 11563 | 01 | MO | ESSENCE | OTHER | 2056665 | 01 | MO | AETNA HMO | OTHER | 1555912 | 01 | MO | CIGNA | OTHER | 2220 | 01 | MO | HEALTHCARE USA | OTHER | 9200025 | 01 | MO | UNITED HEALTHCARE | OTHER | 290274 | 01 | MO | GHP | OTHER |