Provider Demographics
NPI:1730156134
Name:DELACRUZ, NELSONCRIS CAPARAS (IDC)
Entity type:Individual
Prefix:MR
First Name:NELSONCRIS
Middle Name:CAPARAS
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 ALAMANCE CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3560
Mailing Address - Country:US
Mailing Address - Phone:757-563-8693
Mailing Address - Fax:
Practice Address - Street 1:1035 NIDER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2701
Practice Address - Country:US
Practice Address - Phone:757-314-7406
Practice Address - Fax:757-314-7450
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman