Provider Demographics
NPI:1306332457
Name:NAZARIO-CRUZ, CARLOS JAVIER SR
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JAVIER
Last Name:NAZARIO-CRUZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:JAVIER
Other - Last Name:NAZARIO-CRUZ
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PRADERAS DEL RIO
Mailing Address - Street 2:3019 CALLE RIO BUCANA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PRADERAS DEL RIO
Practice Address - Street 2:3019 CALLE RIO BUCANA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-617-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty