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NPI Code Detail

MEDICARE: KORALYS DE LA CRUZ

MEDICARE: KORALYS 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1073478186
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORALYS DE LA CRUZ
Provider Business Mailing Address
First Line : 1689 RANDALL AVE APT 2F
Second Line :
City : BRONX
State : NY
Zip : 10473-4237
Country : US
Telephone Number : 718-864-6547
Fax Number :
Provider Business Practice Location Address
First Line : 579 COURTLANDT AVE
Second Line :
City : BRONX
State : NY
Zip : 10451-5013
Country : US
Telephone Number : 718-485-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2025
Last Update Date : 12/20/2025

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Directions to “ KORALYS DE LA CRUZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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