Provider Demographics
NPI:1477784403
Name:CRUZ, BETHZAIDA
Entity Type:Individual
Prefix:MRS
First Name:BETHZAIDA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GUAYACAN G7
Mailing Address - Street 2:URB. EL PLANTIO
Mailing Address - City:TOA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00949
Mailing Address - Country:UM
Mailing Address - Phone:787-398-6746
Mailing Address - Fax:
Practice Address - Street 1:AJ16 CALLE SONIA
Practice Address - Street 2:VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00949
Practice Address - Country:UM
Practice Address - Phone:787-785-5487
Practice Address - Fax:787-786-9100
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7773183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7773OtherREGISTER CERTIFICATE