Healthcare Provider Details

I. General information

NPI: 1457994683
Provider Name (Legal Business Name): ALEXANDER FRET CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BYP
PONCE PR
00717-1310
US

IV. Provider business mailing address

PO BOX 3583
VEGA ALTA PR
00692-3583
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 832-654-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24504
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: