Provider Demographics
NPI:1235232794
Name:BARBOSA-DE LA CRUZ, NANCY A (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BARBOSA-DE LA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0969
Mailing Address - Country:US
Mailing Address - Phone:787-895-7777
Mailing Address - Fax:787-895-7777
Practice Address - Street 1:CALLE CALIFORNIA B-9
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0974
Practice Address - Country:US
Practice Address - Phone:787-895-7777
Practice Address - Fax:787-895-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-04527Medicare UPIN
PR22314BAMedicare ID - Type Unspecified