Provider Demographics
NPI:1487923728
Name:DE LA CRUZ, JUAN ENRIQUE JR
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ENRIQUE
Last Name:DE LA CRUZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE NUBE #G-19
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:U.S.A
Mailing Address - Zip Code:00731
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:G19 CALLE NUBE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2552
Practice Address - Country:US
Practice Address - Phone:787-432-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163W00000X163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse