Healthcare Provider Details

I. General information

NPI: 1962462184
Provider Name (Legal Business Name): ARIEL CRUZ IGARTUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 AVE F D ROOSEVELT
SAN JUAN PR
00920-2904
US

IV. Provider business mailing address

92 CALLE AZALEA CIUDAD JARDIN I
TOA ALTA PR
00953-4845
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-8272
  • Fax: 787-783-0432
Mailing address:
  • Phone: 787-797-8398
  • Fax: 787-783-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number7787
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: