Provider Demographics
NPI:1649700337
Name:RIVERA CRUZ, RAQUEL M (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:M
Last Name:RIVERA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2650
Mailing Address - Country:US
Mailing Address - Phone:870-541-7211
Mailing Address - Fax:870-541-4297
Practice Address - Street 1:1801 W 40TH AVE STE 6A
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6963
Practice Address - Country:US
Practice Address - Phone:870-541-7393
Practice Address - Fax:870-541-0109
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR76899207Q00000X
390200000X
ARE-15764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program