Provider Demographics
NPI:1487644407
Name:ALBINO CRUZ, ILEANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:ALBINO CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ILEANA
Other - Middle Name:
Other - Last Name:ALBINO CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1688
Mailing Address - Country:US
Mailing Address - Phone:787-890-1674
Mailing Address - Fax:787-890-0335
Practice Address - Street 1:1803 CALLE KENNEDY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690-1210
Practice Address - Country:US
Practice Address - Phone:787-890-1674
Practice Address - Fax:787-890-0335
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9955171W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE75403Medicare UPIN
PR82153Medicare ID - Type Unspecified