Provider Demographics
NPI:1528337110
Name:EMMANUEL DELACRUZ MD PLLC
Entity type:Organization
Organization Name:EMMANUEL DELACRUZ MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:832-631-6120
Mailing Address - Street 1:9595 SIX PINES DR
Mailing Address - Street 2:SUITE 8210
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1531
Mailing Address - Country:US
Mailing Address - Phone:832-631-6120
Mailing Address - Fax:832-631-6280
Practice Address - Street 1:9595 SIX PINES DR
Practice Address - Street 2:SUITE 8210
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1531
Practice Address - Country:US
Practice Address - Phone:832-631-6120
Practice Address - Fax:832-631-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0721208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12272826OtherSTATE OF TEXAS- CAQH
TX1922208164OtherSTATE OF TEXAS- NPI
TXN0721OtherSTATE OF TEXAS-MEDICAL LICENSE NUMBER