Healthcare Provider Details

I. General information

NPI: 1831847029
Provider Name (Legal Business Name): NATASHA ELLI CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO ROCHA COMUNIDAD LASALLE CALLE #13 CASA 279
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 828
MOCA PR
00676-0828
US

V. Phone/Fax

Practice location:
  • Phone: 787-453-7394
  • Fax:
Mailing address:
  • Phone: 787-453-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14316
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001982
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSOCIAL WORK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: