Provider Demographics
NPI:1194256289
Name:DELA CRUZ, JUAN PAULO CUETO (LPN)
Entity type:Individual
Prefix:MR
First Name:JUAN PAULO
Middle Name:CUETO
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W GROVE PKWY APT 218
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4505
Mailing Address - Country:US
Mailing Address - Phone:480-516-4170
Mailing Address - Fax:
Practice Address - Street 1:701 W GROVE PKWY
Practice Address - Street 2:APT 218
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4501
Practice Address - Country:US
Practice Address - Phone:480-516-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP050836164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse