Provider Demographics
NPI:1194721399
Name:CRUZ INTERNAL MEDICINE CORP.
Entity type:Organization
Organization Name:CRUZ INTERNAL MEDICINE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-758-0222
Mailing Address - Street 1:P.O. BOX 190740
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0740
Mailing Address - Country:US
Mailing Address - Phone:787-763-3434
Mailing Address - Fax:787-763-2852
Practice Address - Street 1:407 B FERNANDO MONTILLA ESQ J. J. JIMENEZ
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-3434
Practice Address - Fax:787-763-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
84763OtherSSS
87735Medicare ID - Type Unspecified
G43027Medicare UPIN