=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659311611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINO CRUZ OLIVO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR #3 KM 11.6 BARRIO MARTIN GONZALEZ
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00986-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-477-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RO 95 PLAZA NORTE URB RIACHUELO
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-477-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 9855
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------