Provider Demographics
NPI:1689863847
Name:DE LA CRUZ, ANTHONY C (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:DE LA 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 1:65 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4402
Mailing Address - Country:US
Mailing Address - Phone:626-354-2708
Mailing Address - Fax:
Practice Address - Street 1:280 E DEL MAR BLVD
Practice Address - Street 2:APT# 334
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2770
Practice Address - Country:US
Practice Address - Phone:626-354-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231572207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology