Provider Demographics
NPI:1073878104
Name:DE LA CRUZ PENA, JULIA DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:DENNIS
Last Name:DE LA CRUZ PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5164 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1252
Mailing Address - Country:US
Mailing Address - Phone:407-770-1414
Mailing Address - Fax:
Practice Address - Street 1:5164 CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-1252
Practice Address - Country:US
Practice Address - Phone:407-770-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34471208000000X
FLME156313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL175852Medicaid
FL114684500Medicaid
AL511-66341OtherBC/BS OF AL