Provider Demographics
NPI:1699387191
Name:DELA CRUZ, MATILDE VINOYA (CRNP)
Entity Type:Individual
Prefix:
First Name:MATILDE
Middle Name:VINOYA
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MATILDE
Other - Middle Name:DELA CRUZ
Other - Last Name:SOMOSOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 CAMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6604
Mailing Address - Country:US
Mailing Address - Phone:256-393-8158
Mailing Address - Fax:
Practice Address - Street 1:2692 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5845
Practice Address - Country:US
Practice Address - Phone:256-558-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily