Provider Demographics
NPI:1861622060
Name:CRUZ, VICTOR DAMASO (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DAMASO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:DAMASO
Other - Last Name:CRUZ-HERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1190 E WASHINGTON ST UNIT 113
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3708
Mailing Address - Country:US
Mailing Address - Phone:813-808-3142
Mailing Address - Fax:813-436-8927
Practice Address - Street 1:111 N 12TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3661
Practice Address - Country:US
Practice Address - Phone:813-397-3632
Practice Address - Fax:813-397-3601
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12476208D00000X
FLME117105207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist