Healthcare Provider Details

I. General information

NPI: 1811050578
Provider Name (Legal Business Name): MR. VICTOR CRUZ-COLLAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HH1 CALLE 12 URB. COSTA AZUL
GUAYAMA PR
00784-6730
US

IV. Provider business mailing address

HH1 CALLE 12 URB. COSTA AZUL
GUAYAMA PR
00784-6730
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-9055
  • Fax:
Mailing address:
  • Phone: 787-864-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number1655
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: