MEDICARE: DR. ELSIE IVETTE CRUZ-CUEVAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	12806	PR

General Provider Information

NPI Number	:	1073519716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELSIE IVETTE CRUZ-CUEVAS MD

Provider Business Mailing Address
First Line	:	1056 AVE. MUNOZ RIVERA
Second Line	:	FIRST FEDERAL BLD SUITE 610
City	:	SAN JUAN
State	:	PR
Zip	:	00927
Country	:	US
Telephone Number	:	787-772-4669
Fax Number	:	787-281-7615

Provider Business Practice Location Address
First Line	:	1056 AVE MUNOZ RIVERA
Second Line	:	FIRST FEDERAL BUILDING #1056 SUITE 610
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5015
Country	:	US
Telephone Number	:	787-772-4669
Fax Number	:	787-281-7615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/18/2012

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