Healthcare Provider Details

I. General information

NPI: 1023118676
Provider Name (Legal Business Name): EDITH D. DELA CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEACON PKWY W SUITE 330
BIRMINGHAM AL
35209-3102
US

IV. Provider business mailing address

722 STONE AVE
TALLADEGA AL
35160-2219
US

V. Phone/Fax

Practice location:
  • Phone: 205-715-5910
  • Fax: 205-715-5928
Mailing address:
  • Phone: 256-362-1725
  • Fax: 256-362-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17232
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: