Provider Demographics
NPI:1003276148
Name:DR. EDGAR O. CARO CRUZ
Entity Type:Organization
Organization Name:DR. EDGAR O. CARO CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:O
Authorized Official - Last Name:CARO CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-370-0310
Mailing Address - Street 1:2 CALLE BENITO FEIJOO
Mailing Address - Street 2:URBANIZACION VILLAS DEL ESTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-370-0310
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE BENITO FEIJOO
Practice Address - Street 2:URBANIZACION VILLAS DEL ESTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-370-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR989261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)