Provider Demographics
NPI:1184643157
Name:CRUZ RAMOS, LARA (PSYD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:CRUZ RAMOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HD25 CALLE DOMINGO DE ANDINO
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3622
Mailing Address - Country:US
Mailing Address - Phone:787-469-6042
Mailing Address - Fax:
Practice Address - Street 1:344 CALLE HECTOR SALAMAN
Practice Address - Street 2:EXTENSION ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2112
Practice Address - Country:US
Practice Address - Phone:787-764-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical