Provider Demographics
NPI:1023121696
Name:PEREZ-CRUZ, LUIS A
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:PEREZ-CRUZ
Suffix:
Gender:M
Credentials:
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 1417
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-1417
Mailing Address - Country:US
Mailing Address - Phone:787-863-3084
Mailing Address - Fax:787-863-6300
Practice Address - Street 1:CONQUISTADOR AVE. R-25
Practice Address - Street 2:VEVE CALZADA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-3084
Practice Address - Fax:787-863-6300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029763Medicare ID - Type Unspecified
PRC82401Medicare UPIN