Provider Demographics
NPI:1528077401
Name:VALDES-CRUZ, LILLIAM (MD)
Entity type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:VALDES-CRUZ
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 1:12880 COUNTRY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2743
Mailing Address - Country:US
Mailing Address - Phone:786-385-0559
Mailing Address - Fax:
Practice Address - Street 1:12880 COUNTRY GLEN DR
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-2743
Practice Address - Country:US
Practice Address - Phone:786-385-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME963172080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276778300Medicaid
FLAJ1772ZMedicare UPIN