Healthcare Provider Details

I. General information

NPI: 1538709779
Provider Name (Legal Business Name): OLGA I CRUZ PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION ELLIOT VELEZ J17
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 580
GARROCHALES PR
00652-0580
US

V. Phone/Fax

Practice location:
  • Phone: 939-247-3843
  • Fax:
Mailing address:
  • Phone: 787-452-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6478
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: