Provider Demographics
NPI:1063819456
Name:DE LA CRUZ, ANNETTE
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:DINERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REHABILITATION TECHN
Mailing Address - Street 1:3600 JEROME AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-881-7600
Mailing Address - Fax:718-654-1465
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:718-654-1465
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker