MEDICARE: DELACRUZ HEALTHCARE SERVICES LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1992390629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELACRUZ HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	5728 LITTLE CAPE CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6814
Country	:	US
Telephone Number	:	619-948-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	5728 LITTLE CAPE CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6814
Country	:	US
Telephone Number	:	619-948-4403
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	FLORDELIS DELACRUZ
Credential	:	NP
Telephone Number	:	619-948-4403

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	05/07/2021

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