Provider Demographics
NPI:1235445115
Name:CRUZ BELEN, RAQUEL
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:CRUZ BELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ESTANCIAS DE SAN ANDRES
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-396-4698
Mailing Address - Fax:787-873-1694
Practice Address - Street 1:CALLE ALFONSO XII ESQ. AVE. INTERAMERICANA
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-9911
Practice Address - Fax:787-892-9911
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103TC0700X103K00000X
PR3744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2626785OtherLICENSE