Individual provider · NPI-1

Ivan D Agosto Cruz, 006B

Emergency Medical Technician, Basic · Guaynabo, PR

NPI number1063625838
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1063625838
Entity type
Individual (NPI-1)
Name
Ivan D Agosto Cruz
Credential
006B
Sex
Male
Sole proprietor
No
Enumeration date
May 8, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
146N00000X Emergency Medical Technician, Basic006BPRYes

Practice location

90 Calle San Martin
Guaynabo, PR 00968-1400

Phone 787-754-2550 · Fax 787-781-2063

Mailing address

Po Box 2161
San Juan, PR 00922-2161

Phone 787-754-2550 · Fax 787-781-2063

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