Provider Demographics
NPI:1659458362
Name:CRESPO CRUZ, RAFAEL A (AUD)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:A
Last Name:CRESPO CRUZ
Suffix:
Gender:M
Credentials:AUD
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 561835
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-4275
Mailing Address - Country:US
Mailing Address - Phone:787-259-2311
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:COND. SAN VICENTE OFICINA 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-259-2311
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0490231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0064034Medicare ID - Type Unspecified