Basic Information
Provider Information
NPI: 1134555865
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELA CRUZ
FirstName: ROWENA
MiddleName: HIPOLITO
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10300 W CHARLESTON BLVD STE 13
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891355008
CountryCode: US
TelephoneNumber: 7022339222
FaxNumber: 7026854246
Practice Location
Address1: 10300 W CHARLESTON BLVD STE 13
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891355008
CountryCode: US
TelephoneNumber: 7022339222
FaxNumber: 7026854246
Other Information
ProviderEnumerationDate: 09/26/2013
LastUpdateDate: 09/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LC0200XAPRN001602NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

No ID Information.


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