Provider Demographics
NPI:1750638342
Name:CRUZ CABRERA, IVETTE C
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:C
Last Name:CRUZ CABRERA
Suffix:
Gender:F
Credentials:
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 479
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0479
Mailing Address - Country:US
Mailing Address - Phone:787-397-4174
Mailing Address - Fax:787-544-0600
Practice Address - Street 1:CARR 486 KM 1.9 BARRIO ZANJAS
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-397-4174
Practice Address - Fax:787-544-0600
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1668796246Z00000X, 246ZI1000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZI1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherIllustration, Medical
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No291U00000XLaboratoriesClinical Medical Laboratory