Healthcare Provider Details

I. General information

NPI: 1851352934
Provider Name (Legal Business Name): CARLOS RIVERA CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 AVE LAURO PINERO
CEIBA PR
00735-2701
US

IV. Provider business mailing address

PO BOX 1558
LUQUILLO PR
00773-1558
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-2869
  • Fax:
Mailing address:
  • Phone: 787-889-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6348
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: