Provider Demographics
NPI:1629184965
Name:CRUZ, ANGEL NIEVES (PH)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:NIEVES
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-OESTE MUNOZ RIVERA STREET
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0244
Mailing Address - Country:US
Mailing Address - Phone:787-823-2780
Mailing Address - Fax:787-823-1704
Practice Address - Street 1:MUNOZ RIVERA STREET
Practice Address - Street 2:#11-OESTE
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-0244
Practice Address - Country:US
Practice Address - Phone:787-823-2780
Practice Address - Fax:787-823-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2194OtherPHARMACYST LICENCE