Individual provider Active NPI

Raymund Dela Cruz, P.A.

  • Medical Physician Assistant
  • Waipahu, HI
National Provider Identifier
1578600466
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
AMD 307 Issued in HI
Practice address
94-673 Kupuohi St
#335
Waipahu, HI 96797-5367
Phone
(170) 252-4356
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA771 NV
Medical Physician Assistant 363AM0700X AMD 307 HI Primary

Addresses

Primary practice location

94-673 Kupuohi St
#335
Waipahu, HI 96797-5367

Mailing address

86-260 Farrington Highway
Waianae, HI 96792-3319
Phone (808) 696-7081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040428001254 NV Practitioner - Physician Assistant 0345237657 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
AMD 307HIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care P.a. CurrentSince Oct 23, 2013 Accepting new patients
American Current Care PA CurrentSince Oct 23, 2013 Accepting new patients
Nevada Em-I Silver-Homansky Medical Services Professional Corporation Past Accepting new patients
Lake Mead Emergency Physicians, LLC Past Accepting new patients

Locations

149 N Gibson Rd
Ste H
Henderson, NV 89014
Phone (702) 558-6275

5850 Polaris Ave
Ste 100
Las Vegas, NV 89118
Phone (702) 739-9957

255 Glendale Ave
Ste 12
Sparks, NV 89431
Phone (775) 356-8181

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1578600466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HIGHWAY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923319",
            "telephone_number": "808-696-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-673 KUPUOHI ST",
            "address_2": "#335",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967975367",
            "telephone_number": "170-252-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELA CRUZ",
        "first_name": "RAYMUND",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA771",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "HI",
            "license": "AMD 307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waipahu, HI

Sources for this page

Verify at the official NPI Registry.