Provider Demographics
NPI:1578600466
Name:DELA CRUZ, RAYMUND (PA)
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-260 FARRINGTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3319
Mailing Address - Country:US
Mailing Address - Phone:808-696-7081
Mailing Address - Fax:
Practice Address - Street 1:94-673 KUPUOHI ST
Practice Address - Street 2:#335
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5367
Practice Address - Country:US
Practice Address - Phone:170-252-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA771363AM0700X
HIAMD 307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89320Medicare UPIN