Provider Demographics
NPI:1912019944
Name:CRUZ LOPEZ, PABLO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JOSE
Last Name:CRUZ LOPEZ
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:PO BOX 7161
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7161
Mailing Address - Country:US
Mailing Address - Phone:787-844-0299
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE CENTRAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2109
Practice Address - Country:US
Practice Address - Phone:787-842-7856
Practice Address - Fax:787-842-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14884146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021817Medicare ID - Type UnspecifiedIDENTIFICATION NUMBER