Active NPI
Roderick Brian Dela Cruz
- Medical-Surgical Registered Nurse
- Kenosha, WI
National Provider Identifier
1033730346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical-Surgical Registered Nurse
- License
- 239454
- Practice address
- 9428 69TH St
Kenosha, WI 53142-8111 - Phone
- (262) 344-3892
- NPI assigned
- Apr 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | 239454 | WI | Primary |
Addresses
Primary practice location
9428 69TH St
Kenosha, WI 53142-8111
Mailing address
9428 69TH St
Kenosha, WI 53142-8111
Phone (262) 344-3892
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 239454 | WI | MD | Medical-Surgical Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1033730346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9428 69TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531428111",
"telephone_number": "262-344-3892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9428 69TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531428111",
"telephone_number": "262-344-3892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELA CRUZ",
"first_name": "RODERICK",
"middle_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-28",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "WI",
"license": "239454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.