Provider Demographics
NPI:1902342355
Name:CRUZ OLGUIN, JAEL DARICIA
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:DARICIA
Last Name:CRUZ OLGUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JAEL
Other - Middle Name:DARICIA
Other - Last Name:CRUZ OLGUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:51 CALLE IGLESIA S
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4916
Mailing Address - Country:US
Mailing Address - Phone:939-865-1077
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE IGLESIA S
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4916
Practice Address - Country:US
Practice Address - Phone:939-865-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse