Provider Demographics
NPI:1154423895
Name:CRUZ-CARANDANG, PAMELA AGUILOR (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:AGUILOR
Last Name:CRUZ-CARANDANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MARYWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8179
Mailing Address - Country:US
Mailing Address - Phone:630-510-3914
Mailing Address - Fax:630-510-7067
Practice Address - Street 1:2800 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3831
Practice Address - Country:US
Practice Address - Phone:312-829-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204538Medicare ID - Type Unspecified
ILE60586Medicare UPIN