Provider Demographics
NPI:1053540823
Name:CRUZ ORTIZ, SOAN GILY (MD)
Entity type:Individual
Prefix:DR
First Name:SOAN
Middle Name:GILY
Last Name:CRUZ ORTIZ
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 1:120 AVE CARLOS CHARDON APT 129
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1721
Mailing Address - Country:US
Mailing Address - Phone:787-307-0741
Mailing Address - Fax:
Practice Address - Street 1:611 CALLE PAVIA STE 203
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2242
Practice Address - Country:US
Practice Address - Phone:787-433-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18614207V00000X
NE27397207V00000X
IA41094207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology