Healthcare Provider Details

I. General information

NPI: 1083363873
Provider Name (Legal Business Name): PHILIP TRACE HAAHEOOKALANI DELA CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 ST LUKES BLVD ST LUKES UNIVERSITY HEALTH NETWORK ANDERSON
EASTON PA
18045
US

IV. Provider business mailing address

1700 ST LUKES BLVD ST LUKES UNIVERSITY HEALTH NETWORK ANDERSON
EASTON PA
18045-5670
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1000
  • Fax:
Mailing address:
  • Phone: 484-526-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD496828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: