Provider Demographics
NPI:1548862675
Name:CRUZ MARTINEZ, LILIBETH
Entity type:Individual
Prefix:
First Name:LILIBETH
Middle Name:
Last Name:CRUZ MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 378 PASEO DE LA PALMA REAL
Mailing Address - Street 2:URB. EL VALLE, LOS PRADOS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-428-1176
Mailing Address - Fax:
Practice Address - Street 1:B 10 PASEO DE LA PALMA REAL
Practice Address - Street 2:URB EL VALLE LOS PRADOS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-428-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice