Provider Demographics
NPI:1407548001
Name:DE LA CRUZ, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SW 3RD ST # 301
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4692
Mailing Address - Country:US
Mailing Address - Phone:541-224-5247
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST # 301
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4692
Practice Address - Country:US
Practice Address - Phone:541-224-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health