Healthcare Provider Details

I. General information

NPI: 1629921507
Provider Name (Legal Business Name): DAVID ANTONIO CRUZADO DIAZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 AV. VALERO SUIT 406
FRAJARDO PR
00738
US

IV. Provider business mailing address

404 AV. VALERO SUIT 406
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0101
  • Fax:
Mailing address:
  • Phone: 787-655-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001083
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: