Provider Demographics
NPI:1093700718
Name:NIEVES CRUZ, IVONNE MIGDALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:MIGDALIA
Last Name:NIEVES CRUZ
Suffix:
Gender:F
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 58
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-0058
Mailing Address - Country:US
Mailing Address - Phone:787-875-4225
Mailing Address - Fax:787-875-4225
Practice Address - Street 1:CARR. 7774 KM 0.2 BO. PINAS ABAJO SACTOR LA MORA
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-875-4225
Practice Address - Fax:787-875-4225
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15756208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice