Provider Demographics
NPI:1104271725
Name:HERNANDEZ CRUZ, LAURA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:HERNANDEZ CRUZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 STATE ROAD 66
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-6265
Mailing Address - Country:US
Mailing Address - Phone:786-948-6461
Mailing Address - Fax:
Practice Address - Street 1:2701 STATE ROAD 66
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-6265
Practice Address - Country:US
Practice Address - Phone:786-948-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275453207Q00000X
PR19319208D00000X
FLME157991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice