Provider Demographics
NPI:1669558680
Name:CRUZ-MINGUELA, MARIAN L (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:L
Last Name:CRUZ-MINGUELA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF MEDICO SANTA CRUZ 73 CALLE SANTA CRUZ
Mailing Address - Street 2:STE 305
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6919
Mailing Address - Country:US
Mailing Address - Phone:787-785-2725
Mailing Address - Fax:787-785-2725
Practice Address - Street 1:EDIF MEDICO SANTA CRUZ 73 CALLE SANTA CRUZ
Practice Address - Street 2:STE 305
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6919
Practice Address - Country:US
Practice Address - Phone:787-785-2725
Practice Address - Fax:787-785-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist