Provider Demographics
NPI:1881857621
Name:DE LA CRUZ CORDERO, LUZ M
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:DE LA CRUZ CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:CLINICO
Other - Last Name:HORMIGUEROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:AVE. LUIS MUNOZ MARIN #3
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0788
Mailing Address - Country:US
Mailing Address - Phone:787-849-9485
Mailing Address - Fax:787-827-8014
Practice Address - Street 1:3 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1750
Practice Address - Country:US
Practice Address - Phone:787-849-9485
Practice Address - Fax:787-849-9485
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1380291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038189Medicare PIN