Provider Demographics
NPI:1366420960
Name:CRUZ, CARMEN LILIANA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LILIANA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:LILIANA
Other - Last Name:CRUZ DE TABOAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:CALLE 2 PASEO ALTO 46
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5918
Mailing Address - Country:US
Mailing Address - Phone:787-768-0570
Mailing Address - Fax:787-750-7730
Practice Address - Street 1:PLAZA CAROLINA MALL
Practice Address - Street 2:TERCER NIVEL STE 10
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-750-2620
Practice Address - Fax:787-750-7730
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8791207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8791OtherSTATE PR
8791OtherSTATE PR
D34216Medicare UPIN
29846CRMedicare ID - Type Unspecified