Provider Demographics
NPI:1699457671
Name:MORALES CRUZ, BLANCA ADIANEZ (OTL 1273)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ADIANEZ
Last Name:MORALES CRUZ
Suffix:
Gender:F
Credentials:OTL 1273
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0375
Mailing Address - Country:US
Mailing Address - Phone:787-372-8811
Mailing Address - Fax:
Practice Address - Street 1:800 BLVD SAGRADO CORAZON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3333
Practice Address - Country:US
Practice Address - Phone:787-372-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist