Provider Demographics
NPI:1881673408
Name:BEAUCHAMP-CRUZ, ABRAHAM SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:BEAUCHAMP-CRUZ
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ABRAHAM
Other - Middle Name:
Other - Last Name:BEAUCHAMP CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 5438
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5438
Mailing Address - Country:US
Mailing Address - Phone:787-896-5410
Mailing Address - Fax:787-280-2819
Practice Address - Street 1:20 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2249
Practice Address - Country:US
Practice Address - Phone:787-896-5410
Practice Address - Fax:787-280-2819
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R62319Medicare UPIN