Provider Demographics
NPI:1306856372
Name:CRUZ-ROSARIO, NITIDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIDA
Middle Name:B
Last Name:CRUZ-ROSARIO
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:AVE. JOSE VILLARES ESQ. CORCHADO B-5
Mailing Address - Street 2:URB PARADISE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00672
Mailing Address - Country:US
Mailing Address - Phone:787-862-0822
Mailing Address - Fax:
Practice Address - Street 1:AVE. JOSE VILLARES ESQ. CORCHADO B-5
Practice Address - Street 2:URB. PARADISE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-862-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0041213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48054OtherMEDIGAP REFORMA
PR48054OtherTRIPLE SSS
PR50226OtherPREFERRED MEDICARE CHOISE
PR825758OtherMMM
PR6740101OtherHUMANA PUERTO RICO
PR48054OtherMEDIGAP TRIPLE SSS
PR48054OtherMEDIGAP TRIPLE SSS
PR48054OtherTRIPLE SSS