Basic Information
Provider Information | |||||||||
NPI: | 1255596342 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LA CRUZ RONDON | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 222 W. LAS COLINAS BLVD | ||||||||
Address2: | SUITE 2000 | ||||||||
City: | IRVING | ||||||||
State: | TX | ||||||||
PostalCode: | 75039 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9729573000 | ||||||||
FaxNumber: | 9722360096 | ||||||||
Practice Location | |||||||||
Address1: | 6812 HARRISBURG BLVD | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770114626 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7137154460 | ||||||||
FaxNumber: | 7137154465 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2008 | ||||||||
LastUpdateDate: | 11/13/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/13/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | P2713 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207Q00000X | P2713 | TX | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.