Healthcare Provider Details

I. General information

NPI: 1447570189
Provider Name (Legal Business Name): DARYANA CRUZ-RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 05/11/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE CASA LINDA 1 SUITE 101 CARR 177 LOS FILTROS KM 2.0
BAYAMON PR
00959
US

IV. Provider business mailing address

H78 CALLE 4 URB LAGOS DE PLATA
TOA BAJA PR
00949-3210
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-1996
  • Fax:
Mailing address:
  • Phone: 787-222-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21640
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: