Provider Demographics
NPI:1487080057
Name:DELACRUZ, MELANIE E (COTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 BEACH 138TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1341
Mailing Address - Country:US
Mailing Address - Phone:914-260-1177
Mailing Address - Fax:718-899-9061
Practice Address - Street 1:453 BEACH 138TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1341
Practice Address - Country:US
Practice Address - Phone:914-260-1177
Practice Address - Fax:718-899-9061
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program