Provider Demographics
NPI:1871215137
Name:ROSA CRUZ FERNANDEZ, LISBETH XIOMARA (MD)
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:XIOMARA
Last Name:ROSA CRUZ FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA ISIDRA III
Mailing Address - Street 2:A-18, CALLE B
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:904-591-5013
Mailing Address - Fax:
Practice Address - Street 1:AVE. BARALT
Practice Address - Street 2:AVENIDA PRINCIPAL F-4
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1509208D00000X
PR23066208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7188491OtherIDENTIFICATION