Individual
WANDA CRUZ-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2160 S FIRST AVE, 101 1740 LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153
(708) 216-9000
(708) 216-9033
Mailing address
2160 S FIRST AVE, 101 1740 LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153
(708) 216-9000
(708) 216-9033
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
36055205
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36055205
—
IL
Enumeration date
02/15/2006
Last updated
03/12/2008
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