Basic Information
Provider Information
NPI: 1033559661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRUZ-SALGADO
FirstName: JOSE
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: MSPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6018
Address2:  
City: MAYAGUEZ
State: PR
PostalCode: 006816018
CountryCode: US
TelephoneNumber: 7878304090
FaxNumber: 7878345274
Practice Location
Address1: 59 CALLE MARTINEZ NADAL
Address2: OFICINA 104
City: MAYAGUEZ
State: PR
PostalCode: 00680
CountryCode: US
TelephoneNumber: 7878344090
FaxNumber: 7878345274
Other Information
ProviderEnumerationDate: 06/27/2013
LastUpdateDate: 06/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X001457PRY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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