MEDICARE: EUGENE LOUIS DELA CRUZ DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0775	AZ

General Provider Information

NPI Number	:	1750340139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE LOUIS DELA CRUZ DPM

Provider Business Mailing Address
First Line	:	3101 E SHEA BLVD STE 220204
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3210
Country	:	US
Telephone Number	:	602-993-2700
Fax Number	:	602-993-2700

Provider Business Practice Location Address
First Line	:	19636 N 27TH AVE STE 207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4015
Country	:	US
Telephone Number	:	602-993-2700
Fax Number	:	602-993-2705

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/28/2021

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