Provider Demographics
NPI:1558987982
Name:DE LA CRUZ, HENRY WILLIAM (PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:WILLIAM
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ELM ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3206
Mailing Address - Country:US
Mailing Address - Phone:917-655-8941
Mailing Address - Fax:610-376-3459
Practice Address - Street 1:303 ELM ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3206
Practice Address - Country:US
Practice Address - Phone:917-655-8941
Practice Address - Fax:610-376-3459
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty