MEDICARE: CRUZ ADVANCE MEDICINE LLC

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	207R00000X	Internal Medicine Physician	341826	PR

General Provider Information

NPI Number	:	1770983173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUZ ADVANCE MEDICINE LLC

Provider Business Mailing Address
First Line	:	113 PASEO DEL MAR
Second Line	:
City	:	LUQUILLO
State	:	PR
Zip	:	00773-2902
Country	:	US
Telephone Number	:	787-282-8181
Fax Number	:	787-294-9921

Provider Business Practice Location Address
First Line	:	400 CALLE MANUEL DOMENECH STE 304
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3703
Country	:	US
Telephone Number	:	787-282-8181
Fax Number	:	787-294-9921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PABLO CRUZ-BURGOS
Credential	:	MD
Telephone Number	:	787-282-8181

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	10/21/2023

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