MEDICARE: DR. ILEANA ALBINO CRUZ M.D

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	171W00000X	Contractor	9955	PR
2	208D00000X	General Practice Physician	9955	PR

General Provider Information

NPI Number	:	1487644407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILEANA ALBINO CRUZ M.D

Provider Business Mailing Address
First Line	:	PO BOX 1688
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-1688
Country	:	US
Telephone Number	:	787-890-1674
Fax Number	:	787-890-0335

Provider Business Practice Location Address
First Line	:	1803 CALLE KENNEDY
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-1210
Country	:	US
Telephone Number	:	787-890-1674
Fax Number	:	787-890-0335

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	09/01/2016

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