Provider Demographics
NPI:1659311611
Name:CRUZ OLIVO, REGINO (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINO
Middle Name:
Last Name:CRUZ OLIVO
Suffix:
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:RO 95 PLAZA NORTE
Mailing Address - Street 2:URB RIACHUELO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-0000
Mailing Address - Country:US
Mailing Address - Phone:787-477-7711
Mailing Address - Fax:
Practice Address - Street 1:CARR #3 KM 11.6
Practice Address - Street 2:BARRIO MARTIN GONZALEZ
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986-0000
Practice Address - Country:US
Practice Address - Phone:787-477-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9855208M00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38661200Medicaid