Provider Demographics
NPI:1275829285
Name:DE LA CRUZ, DINA MARIE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:MARIE
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2480
Mailing Address - Country:US
Mailing Address - Phone:956-664-1819
Mailing Address - Fax:956-994-8299
Practice Address - Street 1:4416 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2480
Practice Address - Country:US
Practice Address - Phone:956-664-1819
Practice Address - Fax:956-994-8299
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist