Provider Demographics
NPI:1003132317
Name:CRUZ ESTRADA, KADY (17872)
Entity Type:Individual
Prefix:
First Name:KADY
Middle Name:
Last Name:CRUZ ESTRADA
Suffix:
Gender:F
Credentials:17872
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8413
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8413
Mailing Address - Country:US
Mailing Address - Phone:787-969-1545
Mailing Address - Fax:
Practice Address - Street 1:1200 CARR 849
Practice Address - Street 2:VISTA VERDE APT 334A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4563
Practice Address - Country:US
Practice Address - Phone:787-969-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17872208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice