Provider Demographics
NPI:1265640791
Name:CRUZ, TERESA (MS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D1-9 CALLE PERIFERAL
Mailing Address - Street 2:CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3112
Mailing Address - Country:US
Mailing Address - Phone:787-292-0324
Mailing Address - Fax:
Practice Address - Street 1:A-8 AVE. DEGETAU
Practice Address - Street 2:BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-258-5697
Practice Address - Fax:787-747-2436
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical