Provider Demographics
NPI:1912971755
Name:CRUZADO, NIBALDO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:NIBALDO
Middle Name:ANTONIO
Last Name:CRUZADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BELEN ST. ALTURAS DE SAN PATRICIO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-792-0306
Mailing Address - Fax:787-782-8791
Practice Address - Street 1:5 BELEN ST. ALTURAS DE SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-792-0306
Practice Address - Fax:787-782-8791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5334OtherMEDICAL LICENSE