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General NPI Number Information
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NPI Number | 1255312591
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Entity Type | Individual
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Provider Name | SERVILLANO DELA CRUZ JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 2231 HIGHWAY 44 W
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City | INVERNESS
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State | FL
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Zip | 34453-3879
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Country | US
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Telephone | 352-860-7400
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Fax | 352-860-7450
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Provider Business Mailing Address
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Address Line | 3498 N GRAYHAWK LOOP
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City | LECANTO
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State | FL
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Zip | 34461-8466
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Country | US
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Telephone |
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Fax |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME81376
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License Number State | FL
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