MEDICARE: DR. ONELIA CRESPO-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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	5235	PR

General Provider Information

NPI Number	:	1609082304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ONELIA CRESPO-CRUZ M.D

Provider Business Mailing Address
First Line	:	1485 ASHFORD AVE.
Second Line	:	ST. MARY'S PLAZA 503 SOUTH
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1544
Country	:	US
Telephone Number	:	787-726-2269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 ASHFORD AVE.
Second Line	:	ST. MARY'S PLAZA 503 SOUTH
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1544
Country	:	US
Telephone Number	:	787-726-2269
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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