MEDICARE: NINOSHKA M CRUZ-CORREA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	3464	PR

General Provider Information

NPI Number	:	1578290490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINOSHKA M CRUZ-CORREA

Provider Business Mailing Address
First Line	:	URB LOIZA VALLEY CALLE CRISANTEMO J333
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729
Country	:	US
Telephone Number	:	787-518-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 CALLE CADIZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-3841
Country	:	US
Telephone Number	:	787-781-3187
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	12/07/2023

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Directions to “ NINOSHKA M CRUZ-CORREA ” Practice Location

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