MEDICARE: DR. REBECCA CRUZ PSY.D.

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	103T00000X	Psychologist	001294	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001294	OTHER	PR	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1720355480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA CRUZ PSY.D.

Provider Business Mailing Address
First Line	:	CONDOMINIO VISTA VERDE
Second Line	:	APT 702
City	:	SAN JUAN
State	:	PR
Zip	:	00902
Country	:	US
Telephone Number	:	787-725-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	VISTA VERDE
Second Line	:	APT 702
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4563
Country	:	US
Telephone Number	:	787-725-6500
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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