Provider Demographics
NPI:1922004134
Name:CRUZ BURGOS, PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:CRUZ BURGOS
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 1:113 PASEO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2902
Mailing Address - Country:US
Mailing Address - Phone:919-946-3340
Mailing Address - Fax:787-294-9921
Practice Address - Street 1:400 CALLE MANUEL DOMENECH STE 304
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3703
Practice Address - Country:US
Practice Address - Phone:787-282-8181
Practice Address - Fax:787-294-9921
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87735Medicare PIN