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General NPI Number Information
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NPI Number | 1821293796
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Entity Type | Organization
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Legal Business Name | EDGAR T. DELA CRUZ M.D., INC.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1748 DILLINGHAM BLVD
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City | HONOLULU
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State | HI
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Zip | 96819-4017
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Country | US
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Telephone | 808-848-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 DILLINGHAM BLVD
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City | HONOLULU
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State | HI
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Zip | 96819-4017
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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 | PRESIDENT
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Name | DR. EDGAR T. DELA CRUZ
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Credential | M.D.
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Telephone | 808-848-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13290
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4020
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License Number State | HI
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