Basic Information
| Provider Information | |||||||||
| NPI: | 1174837546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ RIVERA | ||||||||
| FirstName: | RAMON | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 404 | ||||||||
| Address2: | |||||||||
| City: | DORADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006460404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876480810 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 917 AVE TITO CASTRO | ||||||||
| Address2: | HOSPITAL SAN LUCAS | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007170000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 28054 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 146D00000X | 18514 | PR | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 282N00000X | 18514 | PR | Y | Hospitals | General Acute Care Hospital | 282NC0060X | 18514 | PR | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC2000X | 18514 | PR | N | Hospitals | General Acute Care Hospital | Children |
No ID Information.