Provider Demographics
NPI:1912101577
Name:DELA CRUZ, ROBERTO BAYLON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:BAYLON
Last Name:DELA CRUZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E RENNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2227
Mailing Address - Country:US
Mailing Address - Phone:972-234-3311
Mailing Address - Fax:
Practice Address - Street 1:1410 E RENNER RD STE 201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2227
Practice Address - Country:US
Practice Address - Phone:972-234-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC458-205882801Medicaid
TX205882804Medicaid
TXTXB137067Medicare PIN
TX205882804Medicaid
TXC458-205882801Medicaid
TX872T-8L15870Medicare PIN