Provider Demographics
NPI:1023557733
Name:CRUZ, NORMA MERCADO (CAC IV #73881)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:MERCADO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CAC IV #73881
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 12239
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9519
Mailing Address - Country:US
Mailing Address - Phone:787-560-1589
Mailing Address - Fax:
Practice Address - Street 1:168 AVE PERO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5725
Practice Address - Country:US
Practice Address - Phone:787-997-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR136851041C0700X
PR73881101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical