Provider Demographics
NPI:1619068665
Name:NELSON CRUZ, CARL
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:NELSON CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA SULTANITA
Mailing Address - Street 2:553 CALLE J APONTE DE SILVA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-849-6055
Mailing Address - Fax:787-849-6055
Practice Address - Street 1:MATEO FAJARDO 8
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-840-6055
Practice Address - Fax:787-849-6055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6961208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR548487045OtherMEDICAL CARD SYSTEM
PR100150WOtherMEDICARE Y MUCHO MAS
PR1649OtherPREFERRED MEDICARE CHOICE
PR1649OtherPREFERRED MEDICARE CHOICE
PR548487045OtherMEDICAL CARD SYSTEM