Provider Demographics
NPI:1164752614
Name:CRUZ COLON, ILEANA
Entity Type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
Last Name:CRUZ COLON
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 1:126 VISTA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2269
Mailing Address - Country:US
Mailing Address - Phone:939-227-3755
Mailing Address - Fax:
Practice Address - Street 1:126 VISTA HERMOSA
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-2269
Practice Address - Country:US
Practice Address - Phone:939-227-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16670101YM0800X
PR128021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health