Provider Demographics
NPI:1710270749
Name:CRUZ, JANNETTE
Entity Type:Individual
Prefix:MRS
First Name:JANNETTE
Middle Name:
Last Name: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 1:400 AVE LA SIERRA # 177
Mailing Address - Street 2:CUPEY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 AVE LA SIERRA # 177
Practice Address - Street 2:CUPEY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4351
Practice Address - Country:US
Practice Address - Phone:787-292-2050
Practice Address - Fax:787-755-6836
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist