Provider Demographics
NPI:1255312591
Name:DELA CRUZ, SERVILLANO JR (MD)
Entity type:Individual
Prefix:DR
First Name:SERVILLANO
Middle Name:
Last Name:DELA CRUZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3498 N GRAYHAWK LOOP
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2231 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3879
Practice Address - Country:US
Practice Address - Phone:352-860-7400
Practice Address - Fax:352-860-7450
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81376207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260183400Medicaid
FL260183400Medicaid
FLE4764Medicare PIN