MEDICARE: LUIS DE LA CRUZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	28826	SC
2	207RP1001X	Pulmonary Disease Physician	28826	SC
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	28826	SC
4	207R00000X	Internal Medicine Physician	28826	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033138912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS DE LA CRUZ MD

Provider Business Mailing Address
First Line	:	151 HAROLD FLEMING COURT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-573-6320
Fax Number	:	864-573-6323

Provider Business Practice Location Address
First Line	:	151 HAROLD FLEMING COURT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-573-6320
Fax Number	:	864-573-6323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/30/2015

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Directions to “ LUIS DE LA CRUZ MD” Practice Location

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