Provider Demographics
NPI:1679673685
Name:DELACRUZ, MANUELA M (MD)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:M
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 KINGSLEY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4600
Mailing Address - Country:US
Mailing Address - Phone:757-889-6677
Mailing Address - Fax:757-889-6652
Practice Address - Street 1:160 KINGSLEY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4600
Practice Address - Country:US
Practice Address - Phone:757-889-6677
Practice Address - Fax:757-889-6652
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042498207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA415671OtherMDIPA
VA5819199Medicaid
VA4413117OtherAETNA
VA1679673685Medicaid
VA15504OtherOPTIMA
VA325099OtherANTHEM
VA325099OtherANTHEM
VA1679673685Medicaid
VA290000227Medicare ID - Type Unspecified