MEDICARE: KADY CRUZ ESTRADA 17872

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17872	PR

General Provider Information

NPI Number	:	1003132317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KADY CRUZ ESTRADA 17872

Provider Business Mailing Address
First Line	:	PO BOX 8413
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8413
Country	:	US
Telephone Number	:	787-969-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 CARR 849
Second Line	:	VISTA VERDE APT 334A
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4563
Country	:	US
Telephone Number	:	787-969-1545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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