Provider Demographics
NPI:1568202034
Name:CRUZ PADRINO, JUAN CARLOS (NP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:CRUZ PADRINO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 SW 8TH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4674
Mailing Address - Country:US
Mailing Address - Phone:305-456-6055
Mailing Address - Fax:
Practice Address - Street 1:7175 SW 8TH ST STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4674
Practice Address - Country:US
Practice Address - Phone:305-456-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily