Provider Demographics
NPI:1558300616
Name:CRUZ, YVETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:MARIE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HOSTOS AVENUE
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-753-9515
Mailing Address - Fax:787-751-2331
Practice Address - Street 1:405 HOSTOS AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-9515
Practice Address - Fax:787-751-2331
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR158452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI10249Medicare UPIN
PR002-3689Medicare ID - Type Unspecified