Provider Demographics
NPI:1427151729
Name:CRUZ, NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 AVE WINSTON CHURCHILL
Mailing Address - Street 2:URB EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6603
Mailing Address - Country:US
Mailing Address - Phone:787-296-3291
Mailing Address - Fax:787-296-3291
Practice Address - Street 1:309 AVE WINSTON CHURCHILL
Practice Address - Street 2:URB EL SENORIAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6603
Practice Address - Country:US
Practice Address - Phone:787-296-3291
Practice Address - Fax:787-296-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15095208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022010Medicare ID - Type UnspecifiedNUMERO PROVEEDOR
PRH96581Medicare UPIN