MEDICARE: RAMON DE LA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1033638390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON DE LA CRUZ

Provider Business Mailing Address
First Line	:	2649 98TH ST FL 2
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11369-1811
Country	:	US
Telephone Number	:	646-812-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 SCHENECTADY AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2330
Country	:	US
Telephone Number	:	347-915-1112
Fax Number	:	347-915-1113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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Directions to “ RAMON DE LA CRUZ ” Practice Location

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