1215029046 NPI number — GUSTAVO RIVERA CRUZ MD

Table of content: DR. CHRISTY GUENTHER O.D. (NPI 1134566391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215029046 NPI number — GUSTAVO RIVERA CRUZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA CRUZ
Provider First Name:
GUSTAVO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215029046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20000 PMB 563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-7900
Provider Business Mailing Address Fax Number:
787-768-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAGUNA GARDENS SHOPPING CENTER
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-791-8897
Provider Business Practice Location Address Fax Number:
787-791-8801
Provider Enumeration Date:
09/29/2006

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: 2084P0800X , with the licence number:  13764 , 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: 222151 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84357 . This is a "SSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9658 . This is a "INTERNATIONAL MED CARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411255024 . This is a "PROSAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2602997 . This is a "ACAA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1763 . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1937 . This is a "HUMANA VIA APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84357 . This is a "SSS OPTIMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PQ1051 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".




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