Provider Demographics
NPI:1134456049
Name:CRUZ, MARINE (OD)
Entity type:Individual
Prefix:DR
First Name:MARINE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 07 BOX 32028
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-519-4005
Mailing Address - Fax:
Practice Address - Street 1:CALLE HOSTOS #21
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-580-7533
Practice Address - Fax:787-580-7393
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist