Provider Demographics
NPI:1154429231
Name:DE LA CRUZ, MAYRA (MD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:ENCANTADA # PG1 PACIFICA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-614-3162
Mailing Address - Fax:
Practice Address - Street 1:ENCANTADA # PG1 PACIFICA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-614-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11943208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice