Healthcare Provider Details

I. General information

NPI: 1386276335
Provider Name (Legal Business Name): MARCO JOSE DELA CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

PSC 405 BOX 6212
APO AE
09034-0063
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-7018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101273029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: