Provider Demographics
NPI:1518117209
Name:RUIZ-CRUZ, LUIS R (OD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:RUIZ-CRUZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SANTA JUANA II
Mailing Address - Street 2:C/3 A-27
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-638-6885
Mailing Address - Fax:
Practice Address - Street 1:500 JOHN WILL HARRIS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-765-1915
Practice Address - Fax:787-279-1997
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI048152W00000X
PR661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1518117209OtherMCS
PR1518117209OtherHUMANA MEDICARE
PR1518117209OtherTRIPLE S
PR1518117209OtherHUMANA INSURANCE
PR1518117209OtherMCS CLASSICARE
PR1518117209OtherTRIPLE S MEDICARE
PR1518117209OtherHUMANA HEALTH PLAN