Provider Demographics
NPI:1346297850
Name:DE LA CRUZ, A. MARIA (PT)
Entity Type:Individual
Prefix:
First Name:A. MARIA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-6740
Mailing Address - Country:US
Mailing Address - Phone:585-330-4500
Mailing Address - Fax:585-218-0245
Practice Address - Street 1:161 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1726
Practice Address - Country:US
Practice Address - Phone:585-218-0240
Practice Address - Fax:585-218-0245
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB3854Medicare UPIN
NYBA0485Medicare PIN