Provider Demographics
NPI:1275834954
Name:DE LA CRUZ, XOCHITL LENZ (PA)
Entity Type:Individual
Prefix:
First Name:XOCHITL
Middle Name:LENZ
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5624
Mailing Address - Country:US
Mailing Address - Phone:530-876-7995
Mailing Address - Fax:
Practice Address - Street 1:5125 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5624
Practice Address - Country:US
Practice Address - Phone:530-876-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant