Healthcare Provider Details

I. General information

NPI: 1013084334
Provider Name (Legal Business Name): NILSA L CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 AVE HOSTOS PLAYA DE PONCE
PONCE PR
00716-1115
US

IV. Provider business mailing address

PO BOX 220
PONCE PR
00715-0220
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9393
  • Fax:
Mailing address:
  • Phone: 787-843-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number16459
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: