Provider Demographics
NPI:1457974941
Name:DE LA CRUZ, VERONICA A (BSND, IBCLC, CHW)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:A
Last Name:DE LA CRUZ
Suffix:
Gender:
Credentials:BSND, IBCLC, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3921
Mailing Address - Country:US
Mailing Address - Phone:956-331-5955
Mailing Address - Fax:
Practice Address - Street 1:2100 JAY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3921
Practice Address - Country:US
Practice Address - Phone:956-331-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 171M00000X
TX20129172V00000X
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty