Provider Demographics
NPI:1215108261
Name:CRUZ, ADA L
Entity type:Individual
Prefix:MRS
First Name:ADA
Middle Name:L
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 CALLE SAN BERNABE
Mailing Address - Street 2:URB. PALACIOS DE MARBELLA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5227
Mailing Address - Country:US
Mailing Address - Phone:787-799-4322
Mailing Address - Fax:
Practice Address - Street 1:501 WEST MAIN PLAZA DEL SOL
Practice Address - Street 2:AVE. SIERRA BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-0730
Practice Address - Fax:787-740-0620
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist