MEDICARE: MR. NELSONCRIS CAPARAS DELACRUZ I.D.C.

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1730156134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NELSONCRIS CAPARAS DELACRUZ I.D.C.

Provider Business Mailing Address
First Line	:	2689 ALAMANCE CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3560
Country	:	US
Telephone Number	:	757-563-8693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 NIDER BLVD
Second Line	:	SUITE 100
City	:	NORFOLK
State	:	VA
Zip	:	23521-2701
Country	:	US
Telephone Number	:	757-314-7406
Fax Number	:	757-314-7450

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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