Provider Demographics
NPI:1184740474
Name:DE LA CRUZ, GISSELLE C
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:C
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200574
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-0574
Mailing Address - Country:US
Mailing Address - Phone:907-333-1999
Mailing Address - Fax:
Practice Address - Street 1:4640 REKA DR APT E14
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3646
Practice Address - Country:US
Practice Address - Phone:907-333-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator