Individual ProviderRaphy Oniel Ulloa De La CruzSocial WorkerBehavioral Health & Social Service ProvidersPractice Address75 Grand Ave, Englewood, NJ 07631-3522(201) 541-8600PECOS EnrollmentBased on the most recent information from CMS, provider Raphy Oniel Ulloa De La Cruz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1588213656Provider TypeIndividualFull NameUlloa De La Cruz, Raphy OnielGenderMaleSole ProprietorYesEnumeration Date9/10/2019Last Updated9/10/2019Contact InformationPractice LocationPractice Address75 Grand Ave, Englewood, NJ 07631-3522Phone(201) 541-8600Fax(201) 541-8100Mailing LocationMailing Address414 N 11th St Apt 1, Prospect Park, NJ 07508-2213PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer