Healthcare Provider Details

I. General information

NPI: 1174380596
Provider Name (Legal Business Name): ENRIQUE DE LA CRUZ-GALINDO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 KIRBY DR
HOUSTON TX
77045-4859
US

IV. Provider business mailing address

12211 KIRBY DR
HOUSTON TX
77045-4859
US

V. Phone/Fax

Practice location:
  • Phone: 425-315-3109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: