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Individual

RODERICK BRIAN DELA CRUZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
9428 69TH ST, KENOSHA, WI 53142-8111
(262) 344-3892
Mailing address
9428 69TH ST, KENOSHA, WI 53142-8111
(262) 344-3892

Taxonomy

Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
239454
WI

Other

Enumeration date
04/28/2020
Last updated
04/28/2020
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