Healthcare Provider Details

I. General information

NPI: 1720261068
Provider Name (Legal Business Name): VERONICA DE LA CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W STATE STREET
PHARR TX
78577
US

IV. Provider business mailing address

920 W STATE STREET
PHARR TX
78577
US

V. Phone/Fax

Practice location:
  • Phone: 956-283-9822
  • Fax: 956-283-9822
Mailing address:
  • Phone: 956-283-9822
  • Fax: 956-283-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number121237
License Number StateTX

VIII. Authorized Official

Name: MS. VERONICA DE LA CRUZ
Title or Position: OWNER
Credential:
Phone: 956-376-3381