MEDICARE: DR. DEBORAH 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	103TC0700X	Clinical Psychologist	2964	PR
2	104100000X	Social Worker	6871	PR

General Provider Information

NPI Number	:	1750559399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH CRUZ PSY.D

Provider Business Mailing Address
First Line	:	802 CALLE LOLA RODRIGUEZ DE TIO
Second Line	:	URB. COUNTRY CLUB
City	:	SAN JUAN
State	:	PR
Zip	:	00924-2510
Country	:	US
Telephone Number	:	787-616-2477
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE MENDEZ VIGO # 410
Second Line	:	OFICINA # 203 (ALTOS DORADO CAFE)
City	:	DORADO
State	:	PR
Zip	:	00646-4924
Country	:	US
Telephone Number	:	787-616-2477
Fax Number	:

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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