Provider Demographics
NPI:1619001252
Name:CRUZ, ERNESTO LUIS SR (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:LUIS
Last Name:CRUZ
Suffix:SR
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:BOX 418
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00037
Mailing Address - Country:US
Mailing Address - Phone:787-374-3483
Mailing Address - Fax:787-833-7383
Practice Address - Street 1:CARRETBRA #2 AVE
Practice Address - Street 2:HOSTOS 440
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-7383
Practice Address - Fax:787-833-7383
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6134207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine