Provider Demographics
NPI:1588213656
Name:ULLOA DE LA CRUZ, RAPHY ONIEL
Entity Type:Individual
Prefix:
First Name:RAPHY
Middle Name:ONIEL
Last Name:ULLOA DE LA CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N 11TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3522
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8100
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical