Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40888 | CA |
NPI | 1003294505 |
---|---|
Provider Name | Cristina Dela Cruz |
First Address | Moreno Valley, CA 92555-2547 |
Second Address | Moreno Valley, CA 92555-2547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |