Provider Demographics
NPI:1457407249
Name:DE LA CRUZ, MIGUEL DARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:DARIO
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:AA18 CAMINO PANORAMICO
Mailing Address - Street 2:ALTAVILLA, ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6088
Mailing Address - Country:US
Mailing Address - Phone:787-760-5573
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTA CRUZ #73
Practice Address - Street 2:EDIFICIO MEDICO SANTA CRUZ OFICINA 213
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-786-3000
Practice Address - Fax:787-798-6865
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083698Medicare ID - Type Unspecified
PRG02867Medicare UPIN