Healthcare Provider Details

I. General information

NPI: 1942075718
Provider Name (Legal Business Name): GENESIS SOE CRUZ CINTRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 06/12/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 FUTENMA
GINOWAN OKINAWA
96372
JP

IV. Provider business mailing address

PSC 557 BOX 2413
FPO AP
96379-0025
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14901
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: