Provider Demographics
NPI:1104674415
Name:DE LA CRUZ RAMIREZ, SUSSAN YLANAIRY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSSAN
Middle Name:YLANAIRY
Last Name:DE LA CRUZ RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSSAN
Other - Middle Name:YLANAIRY
Other - Last Name:DE LA CRUZ RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1370 AVE SAN IGNACIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3825
Mailing Address - Country:US
Mailing Address - Phone:832-656-8821
Mailing Address - Fax:
Practice Address - Street 1:KM 11.7 PR-2
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:832-656-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program