MEDICARE: LUPE DELACRUZ

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	237700000X	Hearing Instrument Specialist	SC-HAS445	SC

General Provider Information

NPI Number	:	1497080766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUPE DELACRUZ

Provider Business Mailing Address
First Line	:	1904 SUNSET BLVD STE A
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-5954
Country	:	US
Telephone Number	:	803-794-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 SUNSET BLVD STE A
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-5954
Country	:	US
Telephone Number	:	803-794-9244
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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