Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043654833 |
---|---|
Provider Name | Erica Diana De La Cruz |
First Address | Gardena, CA 90248-3523 |
Second Address | Gardena, CA 90248-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 30/05/2013 |