Provider Demographics
NPI:1518921212
Name:DELA CRUZ, MARIA LILY VASCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA LILY
Middle Name:VASCO
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 1:1310 EAST DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-232-7337
Mailing Address - Fax:812-232-7338
Practice Address - Street 1:1310 E DAVIS DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4034
Practice Address - Country:US
Practice Address - Phone:812-232-7337
Practice Address - Fax:812-232-7338
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200507060Medicaid
IN200507060Medicaid
IN224070BMedicare PIN