Provider Demographics
NPI:1962497164
Name:CRUZ-CORREA, MARCIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:R
Last Name:CRUZ-CORREA
Suffix:
Gender:F
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 192880
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2880
Mailing Address - Country:US
Mailing Address - Phone:787-522-3264
Mailing Address - Fax:
Practice Address - Street 1:CLINICA DE LA ESCUELA DE MEDICINA
Practice Address - Street 2:REPARTO METROPOLITANO SHOPPING AVE AMERICO MIRANDA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-522-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12414207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH01471Medicare UPIN
FL62776ZMedicare ID - Type Unspecified