Healthcare Provider Details

I. General information

NPI: 1306901905
Provider Name (Legal Business Name): CAROL DENICE CRUZ PAGAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 EDIF LAS VEGAS #420 BO CAMPO ALEGRE
MANATI PR
00674-1086
US

IV. Provider business mailing address

HC 03 BOX 20755
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7060
  • Fax: 787-854-7021
Mailing address:
  • Phone: 787-222-6287
  • Fax: 787-854-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number582
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: