Provider Demographics
NPI:1063841799
Name:CRUZ-PADILLA, JOSE (LND)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CRUZ-PADILLA
Suffix:
Gender:M
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES DEL CARIBE 108
Mailing Address - Street 2:CALLE ZAFIRO AB 45
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-454-9385
Mailing Address - Fax:
Practice Address - Street 1:MANSIONES DEL CARIBE
Practice Address - Street 2:CALLE ZAFIRO AB-45
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-5205
Practice Address - Country:US
Practice Address - Phone:787-455-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1665133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education