Provider Demographics
NPI:1740511229
Name:CRUZ RIVERA, JOSE ENRIQUE (MS)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:CRUZ RIVERA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CALLE ESTRELLA DEL NORTE
Mailing Address - Street 2:URB.LOS ANGELES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1753
Mailing Address - Country:US
Mailing Address - Phone:787-484-4016
Mailing Address - Fax:
Practice Address - Street 1:58 CALLE ESTRELLA DEL NORTE
Practice Address - Street 2:URB.LOS ANGELES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1753
Practice Address - Country:US
Practice Address - Phone:787-484-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)