Provider Demographics
NPI:1629600713
Name:DELACRUZ-TUASON, MARICHA FANEGA (APRN)
Entity Type:Individual
Prefix:
First Name:MARICHA
Middle Name:FANEGA
Last Name:DELACRUZ-TUASON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 SW 158TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5002
Mailing Address - Country:US
Mailing Address - Phone:954-275-4883
Mailing Address - Fax:
Practice Address - Street 1:829 SW 158TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-5002
Practice Address - Country:US
Practice Address - Phone:954-275-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine