Healthcare Provider Details

I. General information

NPI: 1013181783
Provider Name (Legal Business Name): DIANA I. CRUZ ALEMAN OPTOMETRY DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D54 CALLE CARTAGENA URB LAGO ALTO
TRUJILLO ALTO PR
00976-4050
US

IV. Provider business mailing address

D54 CALLE CARTAGENA URB. LAGO ALTO
TRUJILLO ALTO PR
00976-4050
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-7649
  • Fax: 787-786-1424
Mailing address:
  • Phone: 787-748-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number217
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: