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General NPI Number Information
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NPI Number | 1003174285
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Entity Type | Individual
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Provider Name | JOSE S DE LA CRUZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 13200 SW PACIFIC HWY
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City | TIGARD
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State | OR
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Zip | 97223-4828
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Country | US
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Telephone | 503-598-2000
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Fax | 503-639-0920
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Provider Business Mailing Address
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Address Line | PO BOX 1517
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City | PENDLETON
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State | OR
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Zip | 97801-0410
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Country | US
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Telephone | 877-708-1119
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Fax | 541-278-8349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD189150
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License Number State | OR
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