Healthcare Provider Details

I. General information

NPI: 1003151267
Provider Name (Legal Business Name): ROSELYN ENID RAMIREZ CRUZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 CAMINO DE LAS AZALEAS
DORADO PR
00646-6159
US

IV. Provider business mailing address

652 CAMINO DE LAS AZALEAS
DORADO PR
00646-6159
US

V. Phone/Fax

Practice location:
  • Phone: 939-717-7573
  • Fax:
Mailing address:
  • Phone: 939-717-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number697
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: