Individual
KELVIN ANTONIO DE LA CRUZ CHALJUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
1850 STATE STREET, NEW ALBANY, IN 47150
(812) 944-7701
Mailing address
2017 COVE POINT RD, PORT ORANGE, FL 32128-3025
(386) 500-6225
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
16-724
—
246ZS0410X
Surgical Technologist
Primary
16-724
FL
Other
Enumeration date
08/11/2022
Last updated
08/11/2022
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