Individual
LILLIAN I. CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
N14 AVE AA, TRUJILLO ALTO, PR 00976-3130
(787) 292-6820
Mailing address
6097 JASMINE VINE DR, PORT ORANGE, FL 32128-7117
(386) 690-1880
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
9409
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082519
MEDICARE PROVIDER NUMBER
PR
Enumeration date
08/17/2007
Last updated
08/17/2007
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