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General NPI Number Information
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NPI Number | 1740511229
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Entity Type | Individual
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Provider Name | JOSE ENRIQUE CRUZ RIVERA MS
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Gender | Male
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 58 CALLE ESTRELLA DEL NORTE URB.LOS ANGELES
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City | CAROLINA
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State | PR
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Zip | 00979-1753
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Country | US
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Telephone | 787-484-4016
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Fax |
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Provider Business Mailing Address
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Address Line | 58 CALLE ESTRELLA DEL NORTE URB.LOS ANGELES
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City | CAROLINA
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State | PR
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Zip | 00979-1753
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Country | US
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Telephone | 787-484-4016
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0016
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License Number State | PR
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