Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 29976 | TX |
Y | 213EG0000X | General Practice | 29976 | TX |
NPI | 1003228503 |
---|---|
Provider Name | Dr. Wendell Dela Cruz |
First Address | Houston, TX 77070-3355 |
Second Address | Houston, TX 77070-3355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 09/01/2015 |