Provider Demographics
NPI:1922208164
Name:DELACRUZ, EMMANUEL AVELINO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:AVELINO
Last Name:DELACRUZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2219 SAWDUST RD
Mailing Address - Street 2:UNIT 1203
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2575
Mailing Address - Country:US
Mailing Address - Phone:832-776-1134
Mailing Address - Fax:832-616-3429
Practice Address - Street 1:2219 SAWDUST RD
Practice Address - Street 2:UNIT 1203
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2575
Practice Address - Country:US
Practice Address - Phone:832-776-1134
Practice Address - Fax:832-616-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27611208600000X, 2086S0105X
WAMD600166512086S0105X
TXN0721208200000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312313YUR9OtherMEDICARE PTAN
TX340811401Medicaid