Provider Demographics
NPI:1003193533
Name:DELACRUZ, ANTHONY C
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 MCKINLEY AVE LOT 53
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3699
Mailing Address - Country:US
Mailing Address - Phone:614-507-9412
Mailing Address - Fax:
Practice Address - Street 1:970 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1891
Practice Address - Country:US
Practice Address - Phone:614-507-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33007006175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH45-3789508OtherTAX ID