Healthcare Provider Details

I. General information

NPI: 1245892801
Provider Name (Legal Business Name): SHARON EUNICE CRUZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AVE DR SUSONI
HATILLO PR
00659-1847
US

IV. Provider business mailing address

HC 3 BOX 20755
ARECIBO PR
00612-8236
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4190
  • Fax: 787-262-3984
Mailing address:
  • Phone: 787-356-1412
  • Fax: 787-262-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6298
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: