Provider Demographics
NPI:1598540551
Name:OLIVO CRUZ, NYDIA ENID (THL)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:ENID
Last Name:OLIVO CRUZ
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. DORAVILLE 231 CALLE GRANADA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:939-363-1500
Mailing Address - Fax:
Practice Address - Street 1:38A CARR 696
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5843
Practice Address - Country:US
Practice Address - Phone:787-224-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7502222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist