Provider Demographics
NPI:1841937786
Name:DELA CRUZ, JACINTA
Entity type:Individual
Prefix:MS
First Name:JACINTA
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JACINTA
Other - Middle Name:
Other - Last Name:VASCO-DELACRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1310 E DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4034
Mailing Address - Country:US
Mailing Address - Phone:812-232-7337
Mailing Address - Fax:
Practice Address - Street 1:1310 E DAVIS DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4034
Practice Address - Country:US
Practice Address - Phone:812-232-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003608A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant