Provider Demographics
NPI:1437174018
Name:VALDESCRUZ, RAUL CARLOS (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:CARLOS
Last Name:VALDESCRUZ
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 1:12953 PALMS WEST DR
Mailing Address - Street 2:BLDG 6 SUITE 101
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4990
Mailing Address - Country:US
Mailing Address - Phone:561-795-2400
Mailing Address - Fax:561-795-6813
Practice Address - Street 1:12953 PALMS WEST DR
Practice Address - Street 2:BLDG 6 SUITE 101
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4990
Practice Address - Country:US
Practice Address - Phone:561-795-2400
Practice Address - Fax:561-795-6813
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036445200Medicaid
C48018Medicare UPIN
FL08853WMedicare PIN