Provider Demographics
NPI:1033116967
Name:CRUZ PALOMO, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:CRUZ PALOMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#78 PINERO ST
Mailing Address - Street 2:PUEBLO DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3612
Mailing Address - Country:US
Mailing Address - Phone:787-765-5715
Mailing Address - Fax:787-765-5715
Practice Address - Street 1:#78 PINERO ST
Practice Address - Street 2:PUEBLO DE RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3612
Practice Address - Country:US
Practice Address - Phone:787-765-5715
Practice Address - Fax:787-765-5715
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81116Medicare ID - Type Unspecified
PRD95206Medicare UPIN