Provider Demographics
NPI:1225453061
Name:CRUZ ROMAN, MERCEDES P (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:P
Last Name:CRUZ ROMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 AVE ISLA VERDE APT 301
Mailing Address - Street 2:COND. GALAXY
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4947
Mailing Address - Country:US
Mailing Address - Phone:787-688-5754
Mailing Address - Fax:787-721-1360
Practice Address - Street 1:29 CALLE WASHINGTON STE 409
Practice Address - Street 2:ASHFORD MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1521
Practice Address - Country:US
Practice Address - Phone:787-724-5577
Practice Address - Fax:787-721-1360
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist