Provider Demographics
NPI:1245298926
Name:CRUZ, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name: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 374
Mailing Address - Street 2:SUITE 102 PMB 346
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0374
Mailing Address - Country:US
Mailing Address - Phone:787-975-4993
Mailing Address - Fax:
Practice Address - Street 1:609 AVE TITO CASTRO
Practice Address - Street 2:SUITE 102 PMB 346
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0200
Practice Address - Country:US
Practice Address - Phone:787-319-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58528Medicare UPIN
89199Medicare ID - Type Unspecified