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General NPI Number Information
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NPI Number | 1407671332
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Entity Type | Individual
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Provider Name | GLEN GRACIANO G. DELA CRUZ RN
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Gender | Male
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Dates
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Enumeration Date | 11/16/2024
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 7400 MERTON MINTER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 210-617-5300
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Fax | 210-443-0306
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Provider Business Mailing Address
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Address Line | 7400 MERTON MINTER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 210-617-5300
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Fax | 210-443-0306
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 716341
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 309476
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 660684
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License Number State | CA
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