Active NPI
Wanda Cruzado
- Dentist
- Bayamon, PR
National Provider Identifier
1508975129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2280
- Practice address
- Ave Minillas DC 8
Urb. Santa Juanita
Bayamon, PR 00956 - Phone
- (787) 643-0930
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2280 | PR | Primary |
Addresses
Primary practice location
Ave Minillas DC 8
Urb. Santa Juanita
Bayamon, PR 00956
Mailing address
PO Box 6984
Santa Rosa Unit
Bayamon, PR 00960-5984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180502002862 | PR | Order and Referring Only - Dentist | 5597029306 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2280 | PR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508975129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6984",
"address_2": "SANTA ROSA UNIT",
"city": "BAYAMON",
"state": "PR",
"postal_code": "009605984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "AVE MINILLAS DC 8",
"address_2": "URB. SANTA JUANITA",
"city": "BAYAMON",
"state": "PR",
"postal_code": "00956",
"telephone_number": "787-643-0930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZADO",
"first_name": "WANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PR",
"license": "2280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayamon, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.