Healthcare Provider Details

I. General information

NPI: 1467468942
Provider Name (Legal Business Name): ZORAIDA RODRIGUEZ CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N16 CALLE AA CIUDAD UNIVERSITARIA
TRUJILLO ALTO PR
00976-3130
US

IV. Provider business mailing address

N16 CALLE AA CIUDAD UNIVERSITARIA
TRUJILLO ALTO PUERTO RICO
00976 3119
UM

V. Phone/Fax

Practice location:
  • Phone: 787-755-2697
  • Fax: 787-761-1850
Mailing address:
  • Phone: 787-755-2697
  • Fax: 787-283-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number493
License Number StatePR

VIII. Authorized Official

Name: MS. ZORAIDA RODRIGUEZ
Title or Position: DIRECTOR
Credential: MEDICAL TECHNOLOGY
Phone: 787-755-2697