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General NPI Number Information
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NPI Number | 1174338693
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Entity Type | Individual
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Provider Name | IVELISSE CRUZ DEL ROSARIO
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Gender | Female
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | CARR 2 AVE DON PELAYO URB HACIENDAS DEL NORTE
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-870-4559
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Fax | 787-963-1565
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Provider Business Mailing Address
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Address Line | CARR 2 AVE DON PELAYO URB HACIENDAS DEL NORTE
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-870-4559
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Fax | 787-963-1565
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1448
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License Number State | PR
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