Provider Demographics
NPI:1669814703
Name:CRUZ-ROMAN, GRISEILA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:GRISEILA
Middle Name:MICHELLE
Last Name:CRUZ-ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 2 APT 218B
Mailing Address - Street 2:PARQUE ARCOIRIS 227
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-201-8791
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 APT 218B
Practice Address - Street 2:PARQUE ARCOIRIS 227
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-201-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program