Provider Demographics
NPI:1043228406
Name:CRUZ-CORREA, JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:CRUZ-CORREA
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:PO BOX 8981
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8981
Mailing Address - Country:US
Mailing Address - Phone:787-842-3277
Mailing Address - Fax:787-842-3277
Practice Address - Street 1:917 AVE TITO CASTRO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-842-2377
Practice Address - Fax:787-842-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7454207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027435Medicare PIN