Cruz Azul of WPB

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

LE91892 Issued in FL

Legal business name

CRUZ AZUL OF WPB

Practice address

6294 18TH St S
West Palm BCH, FL 33415-5419

Phone

(561) 201-4016

NPI assigned

Aug 30, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dacha Cruz

Title

President

Phone

(561) 201-4016

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1811278245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6294 18TH ST S",
            "city": "WEST PALM BCH",
            "state": "FL",
            "postal_code": "334155419",
            "telephone_number": "561-201-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6294 18TH ST S",
            "city": "WEST PALM BCH",
            "state": "FL",
            "postal_code": "334155419",
            "telephone_number": "561-201-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRUZ AZUL OF WPB",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "DACHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-201-4016"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "LE91892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMERCIAL INSURANCES PPO HMO",
            "identifier": "1891785994",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in West Palm BCH, FL
• Providers in West Palm BCH, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.