Provider Demographics
NPI:1659593150
Name:CRUZ, AIDA IRIS (MSW)
Entity Type:Individual
Prefix:MISS
First Name:AIDA
Middle Name:IRIS
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:AIDA
Other - Middle Name:IRIS
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:BARRIO QUEMADOS
Mailing Address - Street 2:HC40 BOX 42354
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9865
Mailing Address - Country:US
Mailing Address - Phone:787-529-6436
Mailing Address - Fax:787-763-7515
Practice Address - Street 1:BARRIO QUEMADOS
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9865
Practice Address - Country:US
Practice Address - Phone:787-529-6436
Practice Address - Fax:787-763-7515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5343OtherMSW