Healthcare Provider Details

I. General information

NPI: 1831937937
Provider Name (Legal Business Name): JORGE HERIBERTO DE LA CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 30532
MANATI PR
00674-8513
US

IV. Provider business mailing address

HC 5 BOX 45309
VEGA BAJA PR
00693-9672
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3322
  • Fax: 787-621-3364
Mailing address:
  • Phone: 714-386-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24597
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: