| Doctor Name: | DR. FANNY AGUIRRE DELA CRUZ |
| NPI Number: | 1689742397 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 4301036977 |
| Business Practice Address: | 17880 Farmington Rd Unit B Livonia, MI - 481523104 |
| Business Phone Number: | 7347448560 |
| Business Fax Number: | 7347448563 |
| Mailing Address: | 17880 B, Farmington Rd, LIVONIA |
| State: | MI |
| Postal Code: | 481523104 |
| Phone Number: | 7347448560 |
| Fax Number: | 7347448563 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 03/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301036977 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |