1366420960 NPI number — DR. CARMEN LILIANA CRUZ MD

Table of content: DR. CARMEN LILIANA CRUZ MD (NPI 1366420960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366420960 NPI number — DR. CARMEN LILIANA CRUZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
CARMEN
Provider Middle Name:
LILIANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUZ DE TABOAS
Provider Other First Name:
CARMEN
Provider Other Middle Name:
LILIANA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366420960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 2 PASEO ALTO 46
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-5918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-0570
Provider Business Mailing Address Fax Number:
787-750-7730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA CAROLINA MALL
Provider Second Line Business Practice Location Address:
TERCER NIVEL STE 10
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-750-2620
Provider Business Practice Location Address Fax Number:
787-750-7730
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  8791 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8791 . This is a "STATE PR" identifier . This identifiers is of the category "OTHER".




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