Provider Demographics
NPI:1629489570
Name:DELACRUZ, GISELE (TSHH)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 EAST 149TH STREET
Mailing Address - Street 2:CITY PRO GROUP, INC.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-769-2698
Mailing Address - Fax:
Practice Address - Street 1:11620 224TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1702
Practice Address - Country:US
Practice Address - Phone:914-882-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist