Provider Demographics
NPI:1780835744
Name:CRUZ, MILAGROS (MT)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 44178
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9444
Mailing Address - Country:US
Mailing Address - Phone:787-898-5665
Mailing Address - Fax:787-898-5665
Practice Address - Street 1:CARR 455 K2.2
Practice Address - Street 2:BO. QUEBRADA
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-898-5665
Practice Address - Fax:787-898-5665
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR717291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30833Medicare PIN
PRX15465Medicare UPIN