Provider Demographics
NPI:1770983173
Name:CRUZ ADVANCE MEDICINE LLC
Entity type:Organization
Organization Name:CRUZ ADVANCE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-282-8181
Mailing Address - Street 1:113 PASEO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2902
Mailing Address - Country:US
Mailing Address - Phone:787-282-8181
Mailing Address - Fax:787-294-9921
Practice Address - Street 1:400 CALLE MANUEL DOMENECH STE 304
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3703
Practice Address - Country:US
Practice Address - Phone:787-282-8181
Practice Address - Fax:787-294-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341826207R00000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HY831AMedicare UPIN