Provider Demographics
NPI:1093730483
Name:CRUZ FELICIANO, QUETSY (AUD)
Entity Type:Individual
Prefix:MS
First Name:QUETSY
Middle Name:
Last Name:CRUZ FELICIANO
Suffix:
Gender:F
Credentials:AUD
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 6428
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6428
Mailing Address - Country:US
Mailing Address - Phone:787-833-2155
Mailing Address - Fax:787-833-2177
Practice Address - Street 1:CALLE DE DIEGO E # 55
Practice Address - Street 2:SUITE 105
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4866
Practice Address - Country:US
Practice Address - Phone:787-833-2155
Practice Address - Fax:787-833-2177
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR536231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRSE384ZMedicare PIN
PRFB324AMedicare PIN