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Individual

DR. SALVADOR CRUZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
128 S-UNION, SUITE C, PUEBLO, CO 81003
(719) 543-6988
(719) 542-1290
Mailing address
128 SOUTH UNION, PUEBLO, CO 81003
(719) 543-6988
(719) 542-1290

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
23403
CO
2084P0800X
Psychiatry Physician
Primary
23403
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
076679
CO
01
DB7127
RR MEDICARE - GROUP
01
P00123342
RR MEDICARE - IND
Enumeration date
11/16/2005
Last updated
09/10/2010
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