Provider Demographics
NPI:1841462389
Name:INMOBILIARIA CRUZ FELICIANO
Entity type:Organization
Organization Name:INMOBILIARIA CRUZ FELICIANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-271-1691
Mailing Address - Street 1:PO BOX 1941
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1941
Mailing Address - Country:US
Mailing Address - Phone:787-271-1691
Mailing Address - Fax:787-839-5922
Practice Address - Street 1:PR 3 CENTRO COMERCIAL COOPERATIVO
Practice Address - Street 2:SUITE 2
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-271-1691
Practice Address - Fax:787-271-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR18F34213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165855OtherPK