Healthcare Provider Details

I. General information

NPI: 1972078194
Provider Name (Legal Business Name): ALRIA DELACRUZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5142 BOX MDG
APO AP
96368-5142
US

IV. Provider business mailing address

UNIT 5142
APO AP
96368-5142
US

V. Phone/Fax

Practice location:
  • Phone: 315-360-4780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: