Provider Demographics
NPI:1780131110
Name:PALERMO CRUZ, KARYLANE
Entity type:Individual
Prefix:
First Name:KARYLANE
Middle Name:
Last Name:PALERMO CRUZ
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 261927
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2649
Mailing Address - Country:US
Mailing Address - Phone:787-429-1109
Mailing Address - Fax:
Practice Address - Street 1:300 AVE FELISA RINCON SUITE 1
Practice Address - Street 2:LAS VISTAS SHOPPING VILLAGE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-936-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3118212084N0400X
PR217582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21758OtherLICENSE