Provider Demographics
NPI:1447570189
Name:CRUZ-RIVERA, DARYANA (MD)
Entity Type:Individual
Prefix:
First Name:DARYANA
Middle Name:
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:H78 CALLE 4
Mailing Address - Street 2:URB LAGOS DE PLATA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3210
Mailing Address - Country:US
Mailing Address - Phone:787-222-3571
Mailing Address - Fax:
Practice Address - Street 1:AVE CASA LINDA 1 SUITE 101
Practice Address - Street 2:CARR 177 LOS FILTROS KM 2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21640208000000X
FLME117492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010230600Medicaid