Provider Demographics
NPI:1750340139
Name:DELA CRUZ, EUGENE LOUIS (DPM)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:LOUIS
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 E SHEA BLVD STE 220204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3210
Mailing Address - Country:US
Mailing Address - Phone:602-993-2700
Mailing Address - Fax:602-993-2700
Practice Address - Street 1:19636 N 27TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4015
Practice Address - Country:US
Practice Address - Phone:602-993-2700
Practice Address - Fax:602-993-2705
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0775213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U32430Medicare UPIN
AZZ165658Medicare PIN
U32430Medicare UPIN