Provider Demographics
NPI:1902059447
Name:DE LA CRUZ, KIM INSUA (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:INSUA
Last Name:DE LA CRUZ
Suffix:
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 1:5203 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3932
Mailing Address - Country:US
Mailing Address - Phone:832-247-5403
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DR STE 166
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3771
Practice Address - Country:US
Practice Address - Phone:210-575-8485
Practice Address - Fax:210-575-8537
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0722208600000X, 208G00000X
VA0101242365208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery