Healthcare Provider Details

I. General information

NPI: 1780693739
Provider Name (Legal Business Name): MIGDALIA CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 02 BOX 7898,
AIBONITO PR
00705
US

IV. Provider business mailing address

HC 02 BOX 7898,
AIBONITO PR
00705
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-1320
  • Fax: 787-991-1320
Mailing address:
  • Phone: 787-991-1320
  • Fax: 787-991-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12749
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: