Healthcare Provider Details

I. General information

NPI: 1528519048
Provider Name (Legal Business Name): BRENDA CRUZ M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156N BALDORIOTY
AIBONITO PR
00705
US

IV. Provider business mailing address

156N BALDORIOTY
AIBONITO PR
00705
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-4887
  • Fax:
Mailing address:
  • Phone: 787-735-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4249
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: