Provider Demographics
NPI:1174305486
Name:CRUZ, JULIO ANGEL (EDD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ANGEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SABANA ENEAS CALLE 17 #418
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-212-3668
Mailing Address - Fax:
Practice Address - Street 1:CALLE GAMBOA 1 ESQ GAMBOA BO ANCONES OFICINA 2
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0068
Practice Address - Country:US
Practice Address - Phone:787-328-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health