Provider Demographics
NPI:1609030238
Name:DELA CRUZ, NESTOR ENRIQUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:ENRIQUEZ
Last Name:DELA CRUZ
Suffix:
Gender:M
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:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR FL 1
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-471-7790
Practice Address - Fax:251-471-7096
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT181505207ZP0102X
ALMD.47916207ZP0102X
LAMD.205319207ZP0102X
TXQ9983207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2188364Medicaid