MEDICARE: ZELDA S. DE LA CRUZ, M.D., INC.

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1801165477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZELDA S. DE LA CRUZ, M.D., INC.

Provider Business Mailing Address
First Line	:	638 ALHAMBRA RD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-2258
Country	:	US
Telephone Number	:	650-375-8482
Fax Number	:	650-375-8483

Provider Business Practice Location Address
First Line	:	1 BAYWOOD AVE
Second Line	:	SUITE 7
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1523
Country	:	US
Telephone Number	:	650-375-8482
Fax Number	:	650-375-8483

Authorized Official
Title or Position	:	CEO
Name	:	DR. ZELDA SARMIENTO DE LA CRUZ
Credential	:	M.D.
Telephone Number	:	650-375-8482

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	01/05/2012

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