Provider Demographics
NPI:1588731673
Name:DE LA CRUZ - ROSADO, JULIO ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ANGEL
Last Name:DE LA CRUZ - ROSADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0637
Mailing Address - Country:US
Mailing Address - Phone:787-852-6200
Mailing Address - Fax:787-852-6704
Practice Address - Street 1:269 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3250
Practice Address - Country:US
Practice Address - Phone:787-852-6200
Practice Address - Fax:787-852-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4133204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2000911OtherACAA
PR065072OtherBLUE CROSS BLUE SHIELD
PR2000911OtherACAA