Provider Demographics
NPI:1700244241
Name:CHACON CRUZ, MARCOS E.
Entity Type:Individual
Prefix:DR
First Name:MARCOS E.
Middle Name:
Last Name:CHACON CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VISTAS DEL ATLANTICO CALLE VISTA HERMOSA #119
Mailing Address - Street 2:BUZON 8
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:939-219-4836
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 141.1
Practice Address - Street 2:CALLE JOSE DE DIEGO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14030-I208D00000X
PR216092083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4568502OtherPUERTO RICO LICENSE
PR4568502OtherLICENCE