Provider Demographics
NPI:1871749838
Name:CRUZ PAGAN, IRAIDA (LND)
Entity type:Individual
Prefix:MISS
First Name:IRAIDA
Middle Name:
Last Name:CRUZ PAGAN
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS FILTROS #300 BOULEVARD DEL RIO I
Mailing Address - Street 2:APT 10227
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-607-9696
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1347133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist