Provider Demographics
NPI:1427208024
Name:RODRIGUEZ CRUZ, FIDEL JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:FIDEL
Middle Name:JOEL
Last Name:RODRIGUEZ CRUZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CALLE CORAL, COND LAGO PLAYA
Mailing Address - Street 2:APTO 3012, LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-256-6060
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 19.9
Practice Address - Street 2:EDIF EAST MEDICAL PROFESSIONAL CENTER
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR598156FX1800X
PR733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty