Provider Demographics
NPI:1356083877
Name:DELA CRUZ, ANNE CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CATHERINE
Last Name:DELA CRUZ
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 1:4201 H O LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8154
Mailing Address - Country:US
Mailing Address - Phone:812-243-8298
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 720
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5027
Practice Address - Country:US
Practice Address - Phone:309-495-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program