=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376528125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS SAUL CRUZ-GARCIA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 03/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE UNION #15
-----------------------------------------------------
City | LAJAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00667-1978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-899-1022
-----------------------------------------------------
Fax | 787-851-9153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 426
-----------------------------------------------------
City | BOQUERON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00622-0426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-851-9153
-----------------------------------------------------
Fax | 787-851-9153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 13854
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------