Healthcare Provider Details

I. General information

NPI: 1508445792
Provider Name (Legal Business Name): ALEXIS LUCILLE DE LA CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2301 ERWIN ROAD
DURHAM NC
27710-2890
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-2335
  • Fax: 252-744-3811
Mailing address:
  • Phone: 919-684-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024-00516
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: