Provider Demographics
NPI:1215454095
Name:CRUZ RIVERA, YANITZA (LCDA)
Entity type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:CRUZ RIVERA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197K-17 CALLE ACASIA
Mailing Address - Street 2:URB VALLE ARIBA
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 150 KM 19.7
Practice Address - Street 2:URB. REPARTO DEL CARMEN,
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:UM
Practice Address - Phone:787-204-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6404291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory