Provider Demographics
NPI:1598166274
Name:CRUZADO, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:CRUZADO
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 1:2 CALLE 1
Mailing Address - Street 2:TERRAZAS DE TINTILLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE 1
Practice Address - Street 2:TERRAZAS DE TINTILLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1700
Practice Address - Country:US
Practice Address - Phone:787-564-8711
Practice Address - Fax:787-798-4533
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist