Provider Demographics
NPI:1154377398
Name:ORTIZ-CRUZ, BETHZAIDA (MD)
Entity type:Individual
Prefix:DR
First Name:BETHZAIDA
Middle Name:
Last Name:ORTIZ-CRUZ
Suffix:
Gender:F
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:HC 1 BOX 14938
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9744
Mailing Address - Country:US
Mailing Address - Phone:787-840-0052
Mailing Address - Fax:787-848-1306
Practice Address - Street 1:395 ZONA IND REPARADA 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2348
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:787-848-1306
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14259207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-04521Medicare UPIN
PR0022257Medicare ID - Type Unspecified