Provider Demographics
NPI:1093909889
Name:CRUZ, ELSIE (MT)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MT
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 929
Mailing Address - Street 2:SABANA SECA
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-0929
Mailing Address - Country:US
Mailing Address - Phone:787-795-1080
Mailing Address - Fax:787-795-1080
Practice Address - Street 1:4095 AVE RAMON RIOS ROMAN S2
Practice Address - Street 2:
Practice Address - City:SABANA SECA
Practice Address - State:PR
Practice Address - Zip Code:00952-4095
Practice Address - Country:US
Practice Address - Phone:787-795-1080
Practice Address - Fax:787-795-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2697246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other