Healthcare Provider Details

I. General information

NPI: 1972303402
Provider Name (Legal Business Name): MILAGROS ROQUE-CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILAGROS ROQUE CRUZ

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAPLE ST STE 304
SPRINGFIELD MA
01103-2216
US

IV. Provider business mailing address

HC 11 BOX 47665
CAGUAS PR
00725-9040
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2437
  • Fax:
Mailing address:
  • Phone: 413-737-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: