Provider Demographics
NPI:1417678939
Name:DELA CRUZ, CHRISTINE (MLT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 COLONIAL ARMS CIR APT A3
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3006
Mailing Address - Country:US
Mailing Address - Phone:757-319-9706
Mailing Address - Fax:
Practice Address - Street 1:848 GRANBY ST STE 202
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2009
Practice Address - Country:US
Practice Address - Phone:757-774-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA25694701246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory