Provider Demographics
NPI:1437158466
Name:CRUZ CESTERO, JOSE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:CRUZ CESTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 801057
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1057
Mailing Address - Country:US
Mailing Address - Phone:787-842-2300
Mailing Address - Fax:787-842-7754
Practice Address - Street 1:CARR. 506 AVENUE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-844-4958
Practice Address - Fax:787-844-4958
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11813207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG61260Medicare UPIN