Provider Demographics
NPI:1164457610
Name:RODRIGUEZ CRUZ, BALTAZAR IV
Entity Type:Individual
Prefix:DR
First Name:BALTAZAR
Middle Name:
Last Name:RODRIGUEZ CRUZ
Suffix:IV
Gender:M
Credentials:
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 1427
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1427
Mailing Address - Country:US
Mailing Address - Phone:787-897-1444
Mailing Address - Fax:787-897-4952
Practice Address - Street 1:LARES MEDICAL CENTER HOSPITALES
Practice Address - Street 2:CARR 111 KM 2.9 BO PUEBLO
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-1427
Practice Address - Country:US
Practice Address - Phone:787-897-1444
Practice Address - Fax:787-897-4952
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7727208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice