Basic Information
| Provider Information | |||||||||
| NPI: | 1083158828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-ACEVEDO | ||||||||
| FirstName: | ORLANDO | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 AVE GONZALEZ CLEMENTE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878061687 | ||||||||
| FaxNumber: | 7878061686 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 AVE GONZALEZ CLEMENTE STE 105 | ||||||||
| Address2: | VAL HARBOUR PLAZA | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006821136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878061687 | ||||||||
| FaxNumber: | 7878061686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2016 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 4596 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.