Provider Demographics
NPI:1689920548
Name:DE LA CRUZ HERNANDEZ, ENRIQUE JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:DE LA CRUZ HERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:727-937-3280
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:13045 SUMMERFIELD SQUARE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7402
Practice Address - Country:US
Practice Address - Phone:813-672-1385
Practice Address - Fax:813-672-8904
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2024-05-30
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Provider Licenses
StateLicense IDTaxonomies
FLME143269208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice