Provider Demographics
NPI:1922269653
Name:DE LA CRUZ, JACQUIA (MD)
Entity Type:Individual
Prefix:
First Name:JACQUIA
Middle Name:
Last Name:DE LA CRUZ
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 1:100 MANNING DR
Mailing Address - Street 2:CB 7570
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-6117
Mailing Address - Country:US
Mailing Address - Phone:919-843-2574
Mailing Address - Fax:
Practice Address - Street 1:100 MANNING DR
Practice Address - Street 2:CB 7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6117
Practice Address - Country:US
Practice Address - Phone:919-843-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00443207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery