Provider Demographics
NPI:1134877202
Name:CRUZ, JOHANSEN (DC)
Entity type:Individual
Prefix:
First Name:JOHANSEN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAND BOULEVARD LOS PRADOS
Mailing Address - Street 2:APARTADO 25101
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-989-4222
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 23
Practice Address - Street 2:URBANIZACION MENDEZ HORMAZABAL
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-989-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor