Provider Demographics
NPI:1962117549
Name:AGOSTO CRUZ, ORLANDO I SR
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:I
Last Name:AGOSTO CRUZ
Suffix:SR
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:HC 23 BOX 6422
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9798
Mailing Address - Country:US
Mailing Address - Phone:939-326-8777
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MANGO CALLE POMARROSA CARR 31
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-9798
Practice Address - Country:US
Practice Address - Phone:939-326-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic