Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Reynaldo De la Cruz Jr.

Individual provider Family Nurse Practitioner · NPI 1104630003

Mr. Reynaldo De la Cruz Jr. is a Nurse Practitioner in Forestville, Maryland. Qualified in 2023, 3 years ago. Practices with SNF Physiatry Services MD LLC, a 14-clinician group and accepts Medicare assignment. Licensed in Maryland, Texas and Virginia.

Years since qualifying
3
Licensed in
MD, TX, VA
In the registry since
2025
Specialties on file
3

Practice location Address checks out

7420 Marlboro Pike
Forestville, MD 20747-4343
Phone: (301) 736-0240
Fax: (240) 628-7472
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AC007598 (MD)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 0024192953 (VA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 1194340 (TX)

Record details

NPI number1104630003
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 3, 2025
Last updated in NPPESMay 19, 2026
Certification dateMay 19, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Snf Physiatry Services Md Llc — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Forestville