Provider Demographics
NPI:1215790118
Name:CRUZ CRUZ, IDALIZZE
Entity type:Individual
Prefix:
First Name:IDALIZZE
Middle Name:
Last Name:CRUZ 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:LAS GRANJAS 939
Mailing Address - Street 2:CALLE LOS PADILLA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:939-579-6685
Mailing Address - Fax:
Practice Address - Street 1:LAS GRANJAS 939
Practice Address - Street 2:CALLE LOS PADILLA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:939-579-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist