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General NPI Number Information
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NPI Number | 1871215137
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Entity Type | Individual
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Provider Name | LISBETH XIOMARA ROSA CRUZ FERNANDEZ MD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | AVE. BARALT AVENIDA PRINCIPAL F-4
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-860-5002
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Fax |
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Provider Business Mailing Address
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Address Line | URB. SANTA ISIDRA III A-18, CALLE B
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 904-591-5013
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1509
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23066
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License Number State | PR
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