Healthcare Provider Details

I. General information

NPI: 1043207467
Provider Name (Legal Business Name): NORMA I. CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 AVE PONCE DE LEON SANTURCE MEDICAL MALL, SUITE 412
SANTURCE PR
00909-1900
US

IV. Provider business mailing address

3205 AVE ISLA VERDE COND. THE GALAXY, APT. 1404
CAROLINA PR
00979-4924
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0440
  • Fax: 787-727-5574
Mailing address:
  • Phone: 787-726-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number7057
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: