MEDICARE: DR. RENIER D GONZALEZ CRUZ 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	174400000X	Specialist	7779	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7779	OTHER	PR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1578586079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENIER D GONZALEZ CRUZ MD

Provider Business Mailing Address
First Line	:	58 CALLE MUNOZ RIVERA
Second Line	:	SUITE 1
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-1608
Country	:	US
Telephone Number	:	787-260-1005
Fax Number	:	787-260-1005

Provider Business Practice Location Address
First Line	:	58 CALLE MUNOZ RIVERA
Second Line	:	STE 1
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-1608
Country	:	US
Telephone Number	:	787-260-1005
Fax Number	:	787-260-1005

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/23/2017

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Directions to “ DR. RENIER D GONZALEZ CRUZ MD” Practice Location

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