Healthcare Provider Details

I. General information

NPI: 1114088697
Provider Name (Legal Business Name): PAULA VANESSA DE LA CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA DE LA CRUZ MD

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

2021 PERDIDO ST FL 5
NEW ORLEANS LA
70112-1352
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number236555
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA77095
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number326219
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: