MEDICARE: DR. PABLO CRUZ BURGOS MD

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	11349	PR

General Provider Information

NPI Number	:	1922004134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO CRUZ BURGOS MD

Provider Business Mailing Address
First Line	:	113 PASEO DEL MAR
Second Line	:
City	:	LUQUILLO
State	:	PR
Zip	:	00773-2902
Country	:	US
Telephone Number	:	919-946-3340
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	10/21/2023

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