Provider Demographics
NPI:1184917601
Name:CRUZ, ABDIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ABDIEL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PHD
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 610
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-0610
Mailing Address - Country:US
Mailing Address - Phone:787-448-6007
Mailing Address - Fax:
Practice Address - Street 1:AVE. RIOS ROMAN
Practice Address - Street 2:#59 SUITE 23
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951-0000
Practice Address - Country:US
Practice Address - Phone:787-448-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2113762OtherLICENCE