Provider Demographics
NPI:1518563089
Name:CRUZ SOTO, CARLENE HELIETTE
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:HELIETTE
Last Name:CRUZ SOTO
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 1:271 CALLE MONSENOR BERRIOS
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5832
Mailing Address - Country:US
Mailing Address - Phone:787-600-5776
Mailing Address - Fax:
Practice Address - Street 1:BO CABO CARIBE E33 CALLE 11 URB BRASILIA
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1382156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician