Provider Demographics
NPI:1205690534
Name:MEDINA CRUZ, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MEDINA 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:URB FUENTE BELLA
Mailing Address - Street 2:1419 ST. ROMA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3400
Mailing Address - Country:US
Mailing Address - Phone:787-923-5015
Mailing Address - Fax:
Practice Address - Street 1:URB FUENTE BELLA
Practice Address - Street 2:1419 ST. ROMA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3400
Practice Address - Country:US
Practice Address - Phone:787-923-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98018163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine