Provider Demographics
NPI:1578676425
Name:RIVERA CRUZ, CIPRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CIPRIAN
Middle Name:
Last Name:RIVERA CRUZ
Suffix:
Gender:M
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0098
Mailing Address - Country:US
Mailing Address - Phone:787-262-0849
Mailing Address - Fax:787-262-0849
Practice Address - Street 1:BO. PUENTE SECTOR ZARZA
Practice Address - Street 2:CARR 119 INT.
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-262-0849
Practice Address - Fax:787-262-0849
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10835208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR061481OtherCRUZ AZUL
PR119-10835OtherGLOBAL HEALTH PLAN
PR1-10835OtherCIGNA
PR8-3180OtherTRIPLE S OPTIMO
PR201429OtherPREFERRED HEALTH PLAN
PR4274OtherFIRST MEDICAL
PR6880003OtherHUMANA
PR100318WOtherMMM
PR3529OtherPMC
PR8-3180OtherTRIPLE S
PR8-3180OtherTRIPLE S OPTIMO
PR3529OtherPMC