Provider Demographics
NPI:1073283578
Name:DE LA CRUZ, LERMA D (CNA, CAREGIVER)
Entity Type:Individual
Prefix:
First Name:LERMA
Middle Name:D
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:CNA, CAREGIVER
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2112 E MORELOS ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2374
Mailing Address - Country:US
Mailing Address - Phone:480-748-4387
Mailing Address - Fax:480-748-4387
Practice Address - Street 1:2112 E MORELOS ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2374
Practice Address - Country:US
Practice Address - Phone:480-748-4387
Practice Address - Fax:480-748-4387
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility