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General NPI Number Information
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NPI Number | 1255777009
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Entity Type | Individual
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Provider Name | MRS. LAURA MARIE DE LA CRUZ
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Gender | Female
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 132 SANDALWOOD DR
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City | STATEN ISLAND
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State | NY
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Zip | 10308
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Country | US
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Telephone | 718-966-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 132 SANDALWOOD DR
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City | STATEN ISLAND
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State | NY
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Zip | 10308-1848
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Country | US
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Telephone | 718-966-9314
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 538956111
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License Number State | NY
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