Provider Demographics
NPI:1023984200
Name:CRUZ GONZALEZ, ANDREA MABEL
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MABEL
Last Name:CRUZ GONZALEZ
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 1:629 CARR 709
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2289
Mailing Address - Country:US
Mailing Address - Phone:939-208-5126
Mailing Address - Fax:
Practice Address - Street 1:629 CARR 709
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-2289
Practice Address - Country:US
Practice Address - Phone:939-208-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program