Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 010332 | CT |
NPI | 1003205055 |
---|---|
Provider Name | Marissa Dela Cruz |
First Address | Long Beach, CA 90810-2802 |
Second Address | Long Beach, CA 90810-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2015 |
Last Update Date | 14/01/2015 |