Provider Demographics
NPI:1174212526
Name:DE LA LUZ, DENISE D (MASSGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:D
Last Name:DE LA LUZ
Suffix:
Gender:F
Credentials:MASSGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1455 W PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8178
Mailing Address - Country:US
Mailing Address - Phone:909-793-2225
Mailing Address - Fax:909-793-2221
Practice Address - Street 1:1455 W PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8178
Practice Address - Country:US
Practice Address - Phone:909-793-2225
Practice Address - Fax:909-793-2221
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist