Provider Demographics
NPI:1154734770
Name:CRUZ, JUAN PABLO (PHD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8129
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8129
Mailing Address - Country:US
Mailing Address - Phone:787-798-4592
Mailing Address - Fax:787-798-8236
Practice Address - Street 1:EDIF MEDICO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5041
Practice Address - Country:US
Practice Address - Phone:787-798-4592
Practice Address - Fax:787-798-8236
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical