Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 28826 | SC |
N | 111NI0900X | Internist | 28826 | SC |
N | 207RC0200X | Critical Care Medicine | 28826 | SC |
N | 207RP1001X | Pulmonary Disease | 28826 | SC |
Y | 207RS0012X | Sleep Medicine | 28826 | SC |
NPI | 1033138912 |
---|---|
Provider Name | Luis De La Cruz |
First Address | Spartanburg, SC 29303-4225 |
Second Address | Spartanburg, SC 29303-4225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GP3212 | (05) | SC |
I61854 | (02) |