Provider Demographics
NPI:1538161393
Name:GARCIA, SERAFIN CRUZ JR (MD)
Entity type:Individual
Prefix:
First Name:SERAFIN
Middle Name:CRUZ
Last Name:GARCIA
Suffix:JR
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 1:16600 W SPRAGUE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD STE 120
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6300
Practice Address - Country:US
Practice Address - Phone:440-826-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034119207RC0000X
OH35.034119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228668Medicaid
OH341172609028OtherCARSOURE PIN
OH50983OtherQUAL CHOICE PIN
OH000000128153OtherANTHEM PROVIDER NUMBER
OHC00957Medicare UPIN
OH000000128153OtherANTHEM PROVIDER NUMBER
OHC00957Medicare UPIN