Provider Demographics
NPI:1417668492
Name:DELA CRUZ, ELIZER ANDIE PAMBID
Entity Type:Individual
Prefix:
First Name:ELIZER
Middle Name:ANDIE PAMBID
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56-415 PAHELEHALA LOOP
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2045
Mailing Address - Country:US
Mailing Address - Phone:808-293-0377
Mailing Address - Fax:
Practice Address - Street 1:56-415 PAHELEHALA LOOP
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2045
Practice Address - Country:US
Practice Address - Phone:808-293-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver