Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17872 | PR |
NPI | 1003132317 |
---|---|
Provider Name | Kady Cruz Estrada |
First Address | Ponce, PR 00732-8413 |
Second Address | San Juan, PR 00924-4563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 12/04/2010 |