Healthcare Provider Details

I. General information

NPI: 1508289810
Provider Name (Legal Business Name): MARIA MARGARITA CRUZ 1017
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA MARGARITA CRUZ 1017

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 CATALANA STREET
BARCELONETA PR
00617
US

IV. Provider business mailing address

CALLE CATALANA # 66 EDIF 1
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-717-4571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1017
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier107861800
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: