Provider Demographics
NPI:1033638390
Name:DE LA CRUZ, RAMON
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:DE LA CRUZ
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 1:2649 98TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1811
Mailing Address - Country:US
Mailing Address - Phone:646-812-1090
Mailing Address - Fax:
Practice Address - Street 1:119 SCHENECTADY AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2330
Practice Address - Country:US
Practice Address - Phone:347-915-1112
Practice Address - Fax:347-915-1113
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator