Provider Demographics
NPI:1689210189
Name:GONZALEZ CRUZ, EILEEN REBECCA
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:REBECCA
Last Name:GONZALEZ CRUZ
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:HC 2 BOX 25551
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9320
Mailing Address - Country:US
Mailing Address - Phone:787-299-2566
Mailing Address - Fax:
Practice Address - Street 1:CONCEPCION VERA AYALA
Practice Address - Street 2:KM 10.5
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist