Provider Demographics
NPI:1053602680
Name:CRUZ PITRE, LILLIAM (OTD)
Entity type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:CRUZ PITRE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7526A
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-8903
Mailing Address - Country:US
Mailing Address - Phone:787-354-2413
Mailing Address - Fax:
Practice Address - Street 1:502 AVE BORINQUEN
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4490
Practice Address - Country:US
Practice Address - Phone:787-354-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR767225X00000X
PR2306172171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator