Active NPI
Brandon Balisacan Dela Cruz, IDC
- Independent Duty Corpsman
- Jacksonville, NC
National Provider Identifier
1033398342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- D Street
Building 202
Jacksonville, NC 28542 - Phone
- (910) 450-6109
- NPI assigned
- Nov 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
D Street
Building 202
Jacksonville, NC 28542
Mailing address
PSC Box 20101
Camp Lejeune, NC 28542
Phone (910) 450-6109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1033398342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PSC BOX 20101",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "28542",
"telephone_number": "910-450-6109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "D STREET",
"address_2": "BUILDING 202",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "28542",
"telephone_number": "910-450-6109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELA CRUZ",
"first_name": "BRANDON",
"middle_name": "BALISACAN",
"name_prefix": "Mr.",
"credential": "IDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-02",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.