Healthcare Provider Details

I. General information

NPI: 1134209042
Provider Name (Legal Business Name): CRUZ TORRES JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA PROVIDENCIA 2423 SHEQUEL ST
PONCE PR
00728-3142
US

IV. Provider business mailing address

LA PROVIDENCIA 2423 SHEQUEL ST
PONCE PR
00728-3142
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-9758
  • Fax: 787-824-2022
Mailing address:
  • Phone: 787-842-9758
  • Fax: 787-824-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number834
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: