Healthcare Provider Details

I. General information

NPI: 1528887478
Provider Name (Legal Business Name): KATHERINE CABAN CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO VEGAS ARRIBA
ADJUNTAS PR
00601-9266
US

IV. Provider business mailing address

CARRETERA 5521 BO VEGAS ARRIBA
ADJUNTAS PR
00601-9266
US

V. Phone/Fax

Practice location:
  • Phone: 939-380-4870
  • Fax: 939-380-4870
Mailing address:
  • Phone: 787-232-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14159
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: