MEDICARE: DE LA CRUZ HEALTHCARE CORP

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	261QH0100X	Health Service Clinic/Center
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1124704507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE LA CRUZ HEALTHCARE CORP

Provider Business Mailing Address
First Line	:	971 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	786-351-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	786-351-4243
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MS. MAIRELIS DE LA CRUZ HERNANDEZ
Credential	:	APRN
Telephone Number	:	786-351-4243

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	02/24/2025

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Directions to “DE LA CRUZ HEALTHCARE CORP ” Practice Location

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