Provider Demographics
NPI:1679542344
Name:CRUZ-GONZALEZ, IADELISSE (PHARMD, BCGP)
Entity Type:Individual
Prefix:DR
First Name:IADELISSE
Middle Name:
Last Name:CRUZ-GONZALEZ
Suffix:
Gender:F
Credentials:PHARMD, BCGP
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 223
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0223
Mailing Address - Country:US
Mailing Address - Phone:787-716-0052
Mailing Address - Fax:787-716-0052
Practice Address - Street 1:UPR - SCHOOL OF PHARMACY , DEPT. OF PHARMACY PRACTICE
Practice Address - Street 2:MEDICAL SCIENCES CAMPUS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-754-6995
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31219183500000X, 1835P0018X
PR4433183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist