Provider Demographics
NPI:1114461415
Name:DE LA CRUZ, PATRICIA TREASURE (LAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:TREASURE
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4129
Mailing Address - Country:US
Mailing Address - Phone:415-298-9736
Mailing Address - Fax:
Practice Address - Street 1:809 HEARST AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2077
Practice Address - Country:US
Practice Address - Phone:510-883-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist