MEDICARE: DR. ALEXIS MANUEL CRUZ-CHACON MD

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	207R00000X	Internal Medicine Physician	17501	PR
2	207RH0003X	Hematology & Oncology Physician	17501	PR

General Provider Information

NPI Number	:	1083898969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS MANUEL CRUZ-CHACON MD

Provider Business Mailing Address
First Line	:	600 BLVD DE LA MONTANA APT 383
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7115
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:	787-771-7593

Provider Business Practice Location Address
First Line	:	HOSPITAL AUXILIO MUTUO
Second Line	:	715 PONCE DE LEON PDA 37 1/2
City	:	SAN JUAN
State	:	PR
Zip	:	00919-2712
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:	787-771-7593

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	11/27/2023

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