Provider Demographics
NPI:1508845678
Name:CRUZ-ZENO, EDWIN RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:RODOLFO
Last Name:CRUZ-ZENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1465
Mailing Address - Country:US
Mailing Address - Phone:407-303-1405
Mailing Address - Fax:407-303-1406
Practice Address - Street 1:615 E PRINCETON ST STE 240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1465
Practice Address - Country:US
Practice Address - Phone:407-303-1405
Practice Address - Fax:407-303-1406
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1348082081P0010X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024907100Medicaid
CT001359935Medicaid
CT250000218Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER