Provider Demographics
NPI:1689920548
Name:DE LA CRUZ HERNANDEZ, ENRIQUE JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JOSE
Last Name:DE LA CRUZ HERNANDEZ
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 1:4931 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4348
Mailing Address - Country:US
Mailing Address - Phone:727-937-3280
Mailing Address - Fax:877-327-8156
Practice Address - Street 1:4931 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4348
Practice Address - Country:US
Practice Address - Phone:727-937-3280
Practice Address - Fax:727-943-0301
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143269208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice