Provider Demographics
NPI:1093842569
Name:CRUZ, MADELINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COAMO STREET
Mailing Address - Street 2:BONNEVILLE HEIGHTS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0000
Mailing Address - Country:US
Mailing Address - Phone:787-674-7773
Mailing Address - Fax:
Practice Address - Street 1:14 COAMO STREET
Practice Address - Street 2:BONNEVILLE HEIGHTS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-674-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0962247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information