Healthcare Provider Details

I. General information

NPI: 1588731673
Provider Name (Legal Business Name): JULIO ANGEL DE LA CRUZ - ROSADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 CALLE FONT MARTELO
HUMACAO PR
00791-3250
US

IV. Provider business mailing address

PO BOX 637
HUMACAO PR
00792-0637
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-6200
  • Fax: 787-852-6704
Mailing address:
  • Phone: 787-852-6200
  • Fax: 787-852-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number4133
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: