Healthcare Provider Details

I. General information

NPI: 1114665163
Provider Name (Legal Business Name): MEDICRUZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 467 INT KM 5 BO CAMASEYES
AGUADILLA PR
00603
US

IV. Provider business mailing address

HC 1 BOX 14993
AGUADILLA PR
00603-9255
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZUJEILY MARIE CRUZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-449-2663