Provider Demographics
NPI:1619351103
Name:CRUZ DARDIZ, NICOLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:A
Last Name:CRUZ DARDIZ
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 361513
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1513
Mailing Address - Country:US
Mailing Address - Phone:787-639-5353
Mailing Address - Fax:
Practice Address - Street 1:TORRE MEDICA SUITE 215
Practice Address - Street 2:CARR 21 NUM 1785 AVE LAS LOMAS #21
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-0000
Practice Address - Country:US
Practice Address - Phone:787-639-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19963207RE0101X, 207RE0101X
PR32,290390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism