Provider Demographics
NPI:1174940068
Name:DE JESUS-DE LA CRUZ, HENRY
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:DE JESUS-DE LA CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VIOLETA CONDOMINIO CRISTOBAL
Mailing Address - Street 2:APT 702
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-963-0317
Mailing Address - Fax:
Practice Address - Street 1:AVE SANCHEZ OSORIO ESQ VIA 1
Practice Address - Street 2:URB VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-963-0317
Practice Address - Fax:787-963-0318
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19577207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology