Ivonne Migdalia Nieves Cruz, M.D.

Individual provider Active NPI General Practice Physician · Comerio, PR

NPI 1093700718 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1093700718
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Physician 208D00000X
License
15756 (PR)
Practice address
Carr. 7774 KM 0.2 Bo. Pinas Abajo Sactor la Mora
Comerio, PR 00782
Phone
(787) 875-4225
Fax
(787) 875-4225
NPI assigned
Sep 19, 2005
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20050624000836 PR Practitioner - General Practice 6002851516 Practice locations: Comerio, PR

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
15756PRMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 15756 PR Yes

Addresses

Primary practice location

Carr. 7774 KM 0.2 Bo. Pinas Abajo Sactor la Mora
Comerio, PR 00782

Mailing address

PO Box 58
Comerio, PR 00782-0058
Phone (787) 875-4225

Other providers in Comerio, PR

All providers in Comerio, PR · General Practice Physician in Puerto Rico

Sources for this page

Verify at the official NPI Registry.