Healthcare Provider Details

I. General information

NPI: 1609852383
Provider Name (Legal Business Name): OLGA I CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADMINISTRACION DE SERVICIOS MEDICOS DE PR BOX 2129
SAN JUAN PR
00926
US

IV. Provider business mailing address

1890 CALLE DIEGO SALAZAR FAIRVIEW
SAN JUAN PR
00926-7738
US

V. Phone/Fax

Practice location:
  • Phone: 777-777-3535
  • Fax:
Mailing address:
  • Phone: 787-755-7473
  • Fax: 787-251-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6473
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: