Healthcare Provider Details

I. General information

NPI: 1760963342
Provider Name (Legal Business Name): ANNA V DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 ACCORS
ELMENDORF TX
78112-6003
US

IV. Provider business mailing address

5726 W HAUSMAN RD STE 109
SAN ANTONIO TX
78249-1651
US

V. Phone/Fax

Practice location:
  • Phone: 210-309-1598
  • Fax:
Mailing address:
  • Phone: 210-349-7030
  • Fax: 210-349-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number336313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: