Provider Demographics
NPI:1326056615
Name:CRUZ - RIVERA, IVETTE L (MD)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:L
Last Name:CRUZ - RIVERA
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:HC 3 BOX 25716
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9340
Mailing Address - Country:US
Mailing Address - Phone:787-892-3513
Mailing Address - Fax:787-892-7422
Practice Address - Street 1:HC 01 BOX 25716
Practice Address - Street 2:SAN GERMAN MEDICAL PLAZA SUITE 207
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-3513
Practice Address - Fax:787-892-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12521208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG49559Medicare UPIN
PR0089026Medicare ID - Type UnspecifiedFISIATRA