Provider Demographics
NPI:1124704507
Name:DE LA CRUZ HEALTHCARE CORP
Entity type:Organization
Organization Name:DE LA CRUZ HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAIRELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-351-4243
Mailing Address - Street 1:971 CHIQUITA BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2143
Mailing Address - Country:US
Mailing Address - Phone:786-351-4243
Mailing Address - Fax:
Practice Address - Street 1:971 CHIQUITA BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2143
Practice Address - Country:US
Practice Address - Phone:786-351-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service