Provider Demographics
NPI:1134295371
Name:DE LA CRUZ, ANGEL F (MCD, FAAA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:F
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:MCD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:940 HESTERS CROSSING
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8018
Practice Address - Country:US
Practice Address - Phone:512-244-9024
Practice Address - Fax:512-218-3704
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50670231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199901301Medicaid
TX199901303Medicaid
TX199901302Medicaid
TX8K8547Medicare PIN
TX199901303Medicaid
TX199901302Medicaid
TX199901301Medicaid