MEDICARE: DR. VANESSA THERESA CRUZ ECHEVARRIA DMD

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	122300000X	Dentist	1399	PR

General Provider Information

NPI Number	:	1548267610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA THERESA CRUZ ECHEVARRIA DMD

Provider Business Mailing Address
First Line	:	328 CALLE MARINA
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-2949
Country	:	US
Telephone Number	:	787-868-3920
Fax Number	:	787-868-3920

Provider Business Practice Location Address
First Line	:	328 CALLE MARINA
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-2949
Country	:	US
Telephone Number	:	787-868-3920
Fax Number	:	787-868-3920

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/21/2016

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