Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053620252 |
---|---|
Provider Name | Mrs. Griselda V. De La Cruz |
First Address | Los Angeles, CA 90007 |
Second Address | Commerce, CA 90022-5111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 08/10/2010 |