Provider Demographics
NPI:1578710422
Name:ORTIZ CRUZ, EDDIEMAR (MD)
Entity Type:Individual
Prefix:
First Name:EDDIEMAR
Middle Name:
Last Name:ORTIZ CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDDIEMAR
Other - Middle Name:
Other - Last Name:ORTIZ CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:998 AVE MUNOZ RIVERA
Mailing Address - Street 2:998 AVE MUNOZ RIVERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4308
Mailing Address - Country:US
Mailing Address - Phone:787-722-1248
Mailing Address - Fax:787-721-6098
Practice Address - Street 1:998 AVE MUNOZ RIVERA
Practice Address - Street 2:998 AVE MUNOZ RIVERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4308
Practice Address - Country:US
Practice Address - Phone:787-722-1248
Practice Address - Fax:787-721-6098
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18963207RH0003X
PR12000 I207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine