Provider Demographics
NPI:1992390629
Name:DELACRUZ HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DELACRUZ HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:619-948-4403
Mailing Address - Street 1:5728 LITTLE CAPE CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6814
Mailing Address - Country:US
Mailing Address - Phone:619-948-4403
Mailing Address - Fax:
Practice Address - Street 1:5728 LITTLE CAPE CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6814
Practice Address - Country:US
Practice Address - Phone:619-948-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty