Provider Demographics
NPI:1306961008
Name:CRUZ, ROSA ILEANA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ILEANA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1519 PONCE DE LEON AV
Mailing Address - Street 2:OFFICE 705
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-721-3544
Mailing Address - Fax:787-848-0979
Practice Address - Street 1:1519 PONCE DE LEON AV
Practice Address - Street 2:OFFICE 705
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-721-3544
Practice Address - Fax:787-848-0979
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7129207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029847Medicare ID - Type Unspecified