Healthcare Provider Details

I. General information

NPI: 1750201752
Provider Name (Legal Business Name): ALESSANDRA DE LA CRUZ-CORNELIO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710A JOHN PLATT DR
MOREHEAD CITY NC
28557-4372
US

IV. Provider business mailing address

3710A JOHN PLATT DR
MOREHEAD CITY NC
28557-4372
US

V. Phone/Fax

Practice location:
  • Phone: 252-777-3140
  • Fax: 833-487-1086
Mailing address:
  • Phone: 252-777-3140
  • Fax: 833-487-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828439
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: