Provider Demographics
NPI:1184246944
Name:CARRERAS CRUZ, EDGARDO ARIEL (MD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:ARIEL
Last Name:CARRERAS CRUZ
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:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1191
Mailing Address - Country:US
Mailing Address - Phone:787-221-3245
Mailing Address - Fax:
Practice Address - Street 1:AV AMERICO MIRANDA S/N BARRIO MONACILLOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-3414
Practice Address - Country:US
Practice Address - Phone:787-221-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice