Provider Demographics
NPI:1750325924
Name:DE LA CRUZ, MARITZA (MD)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CALLE SIERRA MORENA
Mailing Address - Street 2:PMB 606
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5583
Mailing Address - Country:US
Mailing Address - Phone:787-400-1835
Mailing Address - Fax:787-746-8079
Practice Address - Street 1:431 AVE PONCE DE LEON
Practice Address - Street 2:PISO 2 OFICINA 202
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-3418
Practice Address - Country:US
Practice Address - Phone:787-400-1835
Practice Address - Fax:787-250-5890
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11007207R00000X
MI11007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG18590Medicare UPIN
PR0083667Medicare ID - Type Unspecified