Healthcare Provider Details

I. General information

NPI: 1487599080
Provider Name (Legal Business Name): MS. CARMENCITA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I29 CALLE CAOBA
CAROLINA PR
00983-1823
US

IV. Provider business mailing address

I29 CALLE CAOBA
CAROLINA PR
00983-1823
US

V. Phone/Fax

Practice location:
  • Phone: 787-627-2843
  • Fax: 787-757-2626
Mailing address:
  • Phone: 787-627-2843
  • Fax: 787-757-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16784
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: