Provider Demographics
NPI:1467767566
Name:DELA CRUZ, MAUREEN OCHOA (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:OCHOA
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13415 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5676
Mailing Address - Country:US
Mailing Address - Phone:815-609-3627
Mailing Address - Fax:815-609-1328
Practice Address - Street 1:13415 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5676
Practice Address - Country:US
Practice Address - Phone:815-609-3627
Practice Address - Fax:815-609-1328
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801OtherGROUP MEDICAID NUMBER
TX00J21AOtherGROUP MEDICARE NUMBER