Provider Demographics
NPI:1407041395
Name:DELA CRUZ, JEFFREY DELA CRUZ (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DELA CRUZ
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1901
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1901
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA001933207R00000X
TXN3608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407041395OtherBLUE CROSS BLUE SHIELD
TX206318201Medicaid
TX8L18955Medicare PIN