Provider Demographics
NPI:1528186624
Name:CRUZ, GRACIELA (1724392)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:1724392
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE.DIEGO VELASQUEZ
Mailing Address - Street 2:E-47 EL CONQUISTADOR
Mailing Address - City:TRUJILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-748-1409
Mailing Address - Fax:
Practice Address - Street 1:AVE.DIEGO VELASQUEZ
Practice Address - Street 2:E-47 EL CONQUISTADOR
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-748-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist