Healthcare Provider Details

I. General information

NPI: 1053653170
Provider Name (Legal Business Name): GERMAN LEROY SERRANO CRUET M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO STE 620
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 800859
COTO LAUREL PR
00780-0859
US

V. Phone/Fax

Practice location:
  • Phone: 787-329-0999
  • Fax:
Mailing address:
  • Phone: 787-329-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number21345
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21345
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: