Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 33007006 | OH |
NPI | 1003193533 |
---|---|
Provider Name | Anthony C Delacruz |
First Address | Columbus, OH 43204-3699 |
Second Address | Urbana, OH 43078-1891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2011 |
Last Update Date | 11/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45-3789508 | TAX ID (01) | OH |