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General NPI Number Information
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NPI Number | 1699460527
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Entity Type | Individual
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Provider Name | KAYLA MARIE DE LA CRUZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2412 JACAMAN RD STE 103
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City | LAREDO
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State | TX
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Zip | 78041-2700
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Country | US
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Telephone | 956-744-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 502 S CLOSNER BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-4660
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1113582
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1113582
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License Number State | TX
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