Provider Demographics
NPI:1407808199
Name:RAFAEL M. DE LA CRUZ MD
Entity Type:Organization
Organization Name:RAFAEL M. DE LA CRUZ MD
Other - Org Name:RAFAEL M. DE LA CRUZ PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:MARCOS
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-544-2420
Mailing Address - Street 1:44 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6258
Mailing Address - Country:US
Mailing Address - Phone:956-544-2420
Mailing Address - Fax:956-544-2879
Practice Address - Street 1:44 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6258
Practice Address - Country:US
Practice Address - Phone:956-544-2420
Practice Address - Fax:956-544-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50016213OtherDPS
TXD3726OtherSTATE LICENSE
TXD3726OtherSTATE LICENSE