Individual
KIM I DE LA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 LEE ST STE 4077, CHARLOTTESVILLE, VA 22908-3771
(434) 924-9300
Mailing address
PO BOX 749112, ATLANTA, GA 30374-9112
(434) 295-1000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101242365
VA
208600000X
Surgery Physician
292123
MA
208600000X
Surgery Physician
N0722
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
0101242365
VA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
292123
MA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
N0722
TX
Other
Enumeration date
10/28/2008
Last updated
10/02/2024
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