Healthcare Provider Details

I. General information

NPI: 1710470521
Provider Name (Legal Business Name): OLGA VERONICA CRUZ MEDICAL TECHNOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLGA CRUZ

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E11 URB PORTAL DEL VALLE
JUANA DIAZ PR
00795-0000
US

IV. Provider business mailing address

PO BOX 7870
PONCE PR
00732-7870
US

V. Phone/Fax

Practice location:
  • Phone: 787-202-5276
  • Fax:
Mailing address:
  • Phone: 787-202-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number7269
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: