Healthcare Provider Details

I. General information

NPI: 1992390629
Provider Name (Legal Business Name): DELACRUZ HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 LITTLE CAPE CT
N LAS VEGAS NV
89081-6814
US

IV. Provider business mailing address

5728 LITTLE CAPE CT
N LAS VEGAS NV
89081-6814
US

V. Phone/Fax

Practice location:
  • Phone: 619-948-4403
  • Fax:
Mailing address:
  • Phone: 619-948-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FLORDELIS DELACRUZ
Title or Position: REGISTERED AGENT
Credential: NP
Phone: 619-948-4403