Provider Demographics
NPI:1083354237
Name:IVETTE L CRUZ RIVERA
Entity Type:Organization
Organization Name:IVETTE L CRUZ RIVERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-3513
Mailing Address - Street 1:HC 3 BOX 25716
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9340
Mailing Address - Country:US
Mailing Address - Phone:787-892-3513
Mailing Address - Fax:787-892-7422
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA SUITE 207
Practice Address - Street 2:CARR 2 KM 174.0
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9340
Practice Address - Country:US
Practice Address - Phone:787-892-3513
Practice Address - Fax:787-892-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty