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General NPI Number Information
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NPI Number | 1477209898
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Entity Type | Organization
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Legal Business Name | HENRY DE JESUS DE LA CRUZ LLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | AVE SANCHEZ OZORIO ESQ VIA 1 VILLA FONTANA
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-963-0317
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Fax | 787-963-0318
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Provider Business Mailing Address
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Address Line | 9 CALLE VIOLETA APT 702
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City | CAROLINA
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State | PR
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Zip | 00979-7370
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Country | US
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Telephone | 787-963-0317
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Fax | 787-963-0318
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. HENRY DE JESUS DE LA CRUZ
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Credential | MD
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Telephone | 787-963-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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