Provider Demographics
NPI:1366470924
Name:DELA CRUZ-PLACER, CARMEN JAGOLINO
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JAGOLINO
Last Name:DELA CRUZ-PLACER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:D
Other - Last Name:PLACER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:815 HICKORY RIDGE RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3159
Mailing Address - Country:US
Mailing Address - Phone:770-381-0125
Mailing Address - Fax:
Practice Address - Street 1:815 HICKORY RIDGE RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3159
Practice Address - Country:US
Practice Address - Phone:770-381-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN152159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse