Provider Demographics
NPI:1518121821
Name:CRUZ, ERICK GUSTAVO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:GUSTAVO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3505
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3505
Mailing Address - Country:US
Mailing Address - Phone:787-832-6626
Mailing Address - Fax:787-833-6626
Practice Address - Street 1:CARR #2 KM 159.0 BO. GUANAJIBO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-6626
Practice Address - Fax:787-833-6626
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17967207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology