Provider Demographics
NPI:1205230281
Name:CRUZ, ROSAYRA LUCIA (LCDA)
Entity Type:Individual
Prefix:MS
First Name:ROSAYRA
Middle Name:LUCIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A-1 CALLE VERDE LUZ
Mailing Address - Street 2:MANSIONES MONTE VERDE #100
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4150
Mailing Address - Country:US
Mailing Address - Phone:939-717-0899
Mailing Address - Fax:
Practice Address - Street 1:A-1 CALLE VERDE LUZ
Practice Address - Street 2:MANSIONES MONTE VERDE #100
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4150
Practice Address - Country:US
Practice Address - Phone:939-717-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1854133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist