MEDICARE: COREY CRUZ FNP

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	363LF0000X	Family Nurse Practitioner	002209	PR

General Provider Information

NPI Number	:	1386299634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY CRUZ FNP

Provider Business Mailing Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	SUIT 3703
City	:	SAN JUAN
State	:	PR
Zip	:	00901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	SUIT 3703
City	:	SAN JUAN
State	:	PR
Zip	:	00901
Country	:	US
Telephone Number	:	919-744-7392
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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