Provider Demographics
NPI:1083069876
Name:ORTIZ-CRUZ, JOAQUIN ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:ROBERTO
Last Name:ORTIZ-CRUZ
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 1:1362 AVE MAGDALENA
Mailing Address - Street 2:APT.802
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2029
Mailing Address - Country:US
Mailing Address - Phone:787-366-7496
Mailing Address - Fax:
Practice Address - Street 1:1362 AVE MAGDALENA
Practice Address - Street 2:APT 802
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2029
Practice Address - Country:US
Practice Address - Phone:787-366-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR223892085N0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program