Provider Demographics
NPI:1891514378
Name:CRUZ LOPEZ, OMAR JARIT (DC)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:JARIT
Last Name:CRUZ LOPEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D3 CALLE TULANE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4927
Mailing Address - Country:US
Mailing Address - Phone:787-579-9905
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE HECTOR M HDEZ SUAREZ
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3314
Practice Address - Country:US
Practice Address - Phone:939-265-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor