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General NPI Number Information
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NPI Number | 1215029046
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Entity Type | Individual
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Provider Name | GUSTAVO RIVERA CRUZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | LAGUNA GARDENS SHOPPING CENTER SUITE 211
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-791-8897
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Fax | 787-791-8801
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Provider Business Mailing Address
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Address Line | PO BOX 20000 PMB 563
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-768-7900
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Fax | 787-768-7900
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13764
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License Number State | PR
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