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General NPI Number Information
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NPI Number | 1013289107
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Entity Type | Individual
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Provider Name | MIRIAN CRUZ CRUZ
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Gender | Female
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | A23 CALLE 1 URB SIERRA LINDA
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City | BAYAMON
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State | PR
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Zip | 00957
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Country | US
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Telephone | 787-367-6818
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RES SIERRA LINDA # URB A23 CALLE 1
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City | BAYAMON
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State | PR
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Zip | 00957-2002
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Country | US
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Telephone | 787-367-6818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 8347
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License Number State | PR
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