Provider Demographics
NPI:1376128074
Name:DELA CRUZ, CORAZON J (LPN)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:J
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1855
Mailing Address - Country:US
Mailing Address - Phone:973-996-8059
Mailing Address - Fax:
Practice Address - Street 1:212 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1855
Practice Address - Country:US
Practice Address - Phone:973-996-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05853400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse