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General NPI Number Information
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NPI Number | 1275743460
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Entity Type | Organization
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Legal Business Name | CRUZADO & CRUZADO MEDICAL GROUP CSP
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 576 CALLE CESAR GONZALEZ 408 DORAL BANK SUITE
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City | SAN JUAN
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State | PR
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Zip | 00918-3756
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Country | US
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Telephone | 787-274-1992
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Fax | 787-751-7357
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Provider Business Mailing Address
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Address Line | 576 CALLE CESAR GONZALEZ 408 DORAL BANK SUITE
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City | SAN JUAN
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State | PR
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Zip | 00918-3756
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Country | US
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Telephone | 787-274-1992
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Fax | 787-751-7357
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Authorized Official
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Title or Position | ACCIONISTA
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Name | DR. ERIQUE CRUZADO
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Credential | M.D.
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Telephone | 787-274-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4924
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License Number State |
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