Provider Demographics
NPI:1821672791
Name:CUBERO CRUZ, WANDA ISAURY
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ISAURY
Last Name:CUBERO 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 1:20335 CARR 480
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-7205
Mailing Address - Country:US
Mailing Address - Phone:787-515-6783
Mailing Address - Fax:
Practice Address - Street 1:20335 CARR 480
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-7205
Practice Address - Country:US
Practice Address - Phone:787-515-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program