Healthcare Provider Details

I. General information

NPI: 1285620476
Provider Name (Legal Business Name): ELISA DEL SOCORRO CRUZ-ARRIGOITIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 135, KM. 64.2 BOX 177
CASTANER PR
00631-0000
US

IV. Provider business mailing address

ROAD 135, KM. 64.2 BOX 177
CASTANER PR
00631-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-2090
  • Fax: 787-829-2913
Mailing address:
  • Phone: 787-460-2090
  • Fax: 787-829-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9148
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: