Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 4133 | PR |
NPI | 1588731673 |
---|---|
Provider Name | Dr. Julio Angel De La Cruz - Rosado |
First Address | Humacao, PR 00792-0637 |
Second Address | Humacao, PR 00791-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065072 | BLUE CROSS BLUE SHIELD (01) | PR |
2000911 | ACAA (01) | PR |
C79406 | (02) | PR |