Provider Demographics
NPI:1427203140
Name:DE LA CRUZ, JOANNA MAE CADIZ (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOANNA MAE
Middle Name:CADIZ
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JOANNA MAE
Other - Middle Name:CALLATES
Other - Last Name:CADIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20136 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1102
Mailing Address - Country:US
Mailing Address - Phone:347-479-2421
Mailing Address - Fax:
Practice Address - Street 1:403 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2664
Practice Address - Country:US
Practice Address - Phone:213-742-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030189225100000X
CA2947172251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist