Provider Demographics
NPI:1174828230
Name:CRUZ, WILMA (LND)
Entity Type:Individual
Prefix:MISS
First Name:WILMA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOSE SEVERO QUINONES
Mailing Address - Street 2:EE-16 SANCHEZ ROHNA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-203-0211
Mailing Address - Fax:787-730-7073
Practice Address - Street 1:H2 AVE CASTIGLIONI
Practice Address - Street 2:BAYAMON GARDEN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2427
Practice Address - Country:US
Practice Address - Phone:787-203-0211
Practice Address - Fax:787-730-7073
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1476133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered