Provider Demographics
NPI:1417376526
Name:MONTES CRUZ, PABLO SR
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:MONTES CRUZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO TORRES DE CERVANTES
Mailing Address - Street 2:APARTAMENTO 1009A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-256-0273
Mailing Address - Fax:787-876-7856
Practice Address - Street 1:COND TORRES DE CERVANTES
Practice Address - Street 2:1009 A
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00924
Practice Address - Country:UM
Practice Address - Phone:787-256-0273
Practice Address - Fax:787-878-7856
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16830104100000X
PR144461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker