Provider Demographics
NPI:1891938841
Name:CRUZ-GONZALEZ, MYRNA
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:
Last Name:CRUZ-GONZALEZ
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:URBANIZACION SANTA MARINA 135 SANTA TERESA
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:P.R.
Mailing Address - Zip Code:000678
Mailing Address - Country:UM
Mailing Address - Phone:939-243-8796
Mailing Address - Fax:787-895-5366
Practice Address - Street 1:HC 3 BOX 16276
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9818
Practice Address - Country:US
Practice Address - Phone:787-895-5366
Practice Address - Fax:787-895-5366
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7847104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker