Basic Information
| Provider Information | |||||||||
| NPI: | 1992000855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IDXPERT, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1465 | ||||||||
| Address2: | |||||||||
| City: | SABANA SECA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009521465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 3142220614 | ||||||||
| Practice Location | |||||||||
| Address1: | HIMA-SAN PABLO CAGUAS HOSPITAL | ||||||||
| Address2: | 100 LUIS MUNOZ MARIN AVE., URB. MARIOLGA | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 3142220614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2011 | ||||||||
| LastUpdateDate: | 09/04/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7876533434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 17784 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | EM624A | 01 | PR | MEDICARE PTAN | OTHER | 8757559 | 01 | CIGNA | OTHER |