Healthcare Provider Details

I. General information

NPI: 1891938841
Provider Name (Legal Business Name): MRS. MYRNA CRUZ-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 3 BOX 16276
QUEBRADILLAS PR
00678-9648
US

IV. Provider business mailing address

HC 3 BOX 16276
QUEBRADILLAS P.R.
000678
UM

V. Phone/Fax

Practice location:
  • Phone: 939-274-5826
  • Fax: 787-895-5366
Mailing address:
  • Phone: 939-243-8796
  • Fax: 787-895-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9015
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: