Basic Information
| Provider Information | |||||||||
| NPI: | 1386850006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ-CRUZ | ||||||||
| FirstName: | JORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
| FaxNumber: | 5059235354 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 CEDAR ST SE | ||||||||
| Address2: | STE 5630 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055636399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | DR.0059830 | CO | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 41118 | AZ | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | M-2305 | GU | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD2021-1076 | NM | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.