Healthcare Provider Details

I. General information

NPI: 1669183414
Provider Name (Legal Business Name): LEISHLA RIVERA CRUZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB INDUSTRIAL REPARADA 2 396 DR. LUIS F. SALA
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number72912
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: