Individual
MAICA PUNZALAN DELA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2850 SE POWELL VALLEY RD, GRESHAM, OR 97080-1494
(503) 666-5050
(503) 666-1162
Mailing address
6255 SHERIDAN DR, SUITE 304, WILLIAMSVILLE, NY 14221-4836
(716) 630-2587
(716) 857-8944
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
018490
NY
363A00000X
Physician Assistant
Primary
PA188907
OR
363AM0700X
Medical Physician Assistant
018490
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018490
NEW YORK STATE LICENSE NUMBER
NY
Enumeration date
03/04/2015
Last updated
02/07/2020
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