MEDICARE: EUGENE L DE LA CRUZ DPM PC

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	208600000X	Surgery Physician		AZ

General Provider Information

NPI Number	:	1184072894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE L DE LA CRUZ DPM PC

Provider Business Mailing Address
First Line	:	1743 W SIENNA BOUQUET PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 W SIENNA BOUQUET PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8040
Country	:	US
Telephone Number	:	631-827-8159
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MATHEW JAMES
Credential	:
Telephone Number	:	631-827-8159

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	06/03/2016

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