Provider Demographics
NPI:1639169253
Name:CRUZ-CABANAS, GRIMANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:GRIMANESSA
Middle Name:
Last Name:CRUZ-CABANAS
Suffix:
Gender:F
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:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0486
Mailing Address - Country:US
Mailing Address - Phone:787-743-3886
Mailing Address - Fax:787-286-5180
Practice Address - Street 1:HIMA PLAZA UNO, 500 AVE DEGETAU
Practice Address - Street 2:SUITE 411
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7307
Practice Address - Country:US
Practice Address - Phone:787-743-3886
Practice Address - Fax:787-286-5180
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30934Medicare UPIN
0088494Medicare ID - Type Unspecified