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General NPI Number Information
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NPI Number | 1346873270
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Entity Type | Individual
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Provider Name | CAITLIN DE LA CRUZ CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1066 E BETHLEHEM BLVD
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City | WHEELING
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State | WV
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Zip | 26003-4961
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Country | US
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Telephone | 304-242-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 2275 SWALLOW HILL RD STE 2400
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City | PITTSBURGH
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State | PA
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Zip | 15220-1676
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SP020831
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 105726
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License Number State | WV
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