Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2012-00443 | NC |
NPI | 1922269653 |
---|---|
Provider Name | Jacquia De La Cruz |
First Address | Chapel Hill, NC 27599-6117 |
Second Address | Chapel Hill, NC 27599-6117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 01/02/2022 |