Provider Demographics
NPI:1053022574
Name:CRUZ IRIZARRY, CRISTINA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIE
Last Name:CRUZ IRIZARRY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#105 URB. COUNTRY HILLS
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650
Mailing Address - Country:US
Mailing Address - Phone:939-331-1339
Mailing Address - Fax:
Practice Address - Street 1:63 AVE MUNOZ RIVERA OESTE
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2637
Practice Address - Country:US
Practice Address - Phone:787-898-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered