Provider Demographics
NPI:1821140807
Name:RODRIGUEZ CRUZ, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:RODRIGUEZ CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 CALLE ALICANTE
Mailing Address - Street 2:URB. BAHIA VISTAMAR
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1470
Mailing Address - Country:US
Mailing Address - Phone:787-762-3240
Mailing Address - Fax:787-762-3240
Practice Address - Street 1:30 A-10 'AVE' ROBERTO CLEMENTE
Practice Address - Street 2:URB VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9847208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9847OtherPUERTO RICO LICENSE
PR9847OtherPUERTO RICO LICENSE
PR83372Medicare ID - Type UnspecifiedGENERAL PRACTICE