Provider Demographics
NPI:1639515083
Name:CRUZ, ROSA H (LIC)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:H
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1292
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:P.R.
Mailing Address - Zip Code:00735
Mailing Address - Country:UM
Mailing Address - Phone:787-633-4859
Mailing Address - Fax:
Practice Address - Street 1:URB. BARALT CALLE MARGINAL A 49
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3759
Practice Address - Country:US
Practice Address - Phone:787-801-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3996103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling