Provider Demographics
NPI:1609184555
Name:ALBERTO R DE LA CRUZ MD PA
Entity Type:Organization
Organization Name:ALBERTO R DE LA CRUZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-342-4242
Mailing Address - Street 1:719 W COKE RD
Mailing Address - Street 2:STE.7
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3011
Mailing Address - Country:US
Mailing Address - Phone:903-342-4242
Mailing Address - Fax:903-342-4055
Practice Address - Street 1:719 W COKE RD
Practice Address - Street 2:STE.7
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3011
Practice Address - Country:US
Practice Address - Phone:903-342-4242
Practice Address - Fax:903-342-4055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERTO R DE LA CRUZ MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7443208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128113102Medicaid
TX128113102Medicaid