=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760747901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUIS J CRUZ CINTRON MD, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2012
-----------------------------------------------------
Last Update Date | 07/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EDIF PORRATA PILA AVE LAS AMERICAS SUITE 210
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-501-3188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EDIF PORRATA PILA AVE LAS AMERICAS SUITE 210
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-501-3188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. LUIS J CRUZ CINTRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-501-3188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 12546
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------