Provider Demographics
NPI:1265491963
Name:GONZALEZ CRUZ, JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:GONZALEZ CRUZ
Suffix:
Gender:M
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 9067
Mailing Address - Street 2:PAMPANOS STATION
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9067
Mailing Address - Country:US
Mailing Address - Phone:787-259-5031
Mailing Address - Fax:787-290-2277
Practice Address - Street 1:EDIFICIO PARRA PONCE BY PASS
Practice Address - Street 2:SUITE 704
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-259-5031
Practice Address - Fax:787-290-2277
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH80612Medicare UPIN
PR20201Medicare ID - Type Unspecified