Basic Information
| Provider Information | |||||||||
| NPI: | 1578600466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELA CRUZ | ||||||||
| FirstName: | RAYMUND | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86-260 FARRINGTON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 94-673 KUPUOHI ST | ||||||||
| Address2: | #335 | ||||||||
| City: | WAIPAHU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967975367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1702524356 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA771 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | AMD 307 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.