Provider Demographics
NPI:1467093385
Name:DELA CRUZ, BENILDA RIVERA
Entity Type:Individual
Prefix:
First Name:BENILDA
Middle Name:RIVERA
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 55TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4648
Mailing Address - Country:US
Mailing Address - Phone:212-380-6299
Mailing Address - Fax:
Practice Address - Street 1:4140 55TH ST FL 1
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4648
Practice Address - Country:US
Practice Address - Phone:212-380-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse