Provider Demographics
NPI:1437912607
Name:DE LA CRUZ, MACKENZIE LYNNE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LYNNE
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 1:9706 COTTON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2288
Mailing Address - Country:US
Mailing Address - Phone:760-277-1625
Mailing Address - Fax:
Practice Address - Street 1:9706 COTTON CREEK DR
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2288
Practice Address - Country:US
Practice Address - Phone:760-277-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula