Provider Demographics
NPI:1447611207
Name:DELA CRUZ, JAIRIN (MD,BCBA)
Entity Type:Individual
Prefix:
First Name:JAIRIN
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:MD,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1916
Mailing Address - Country:US
Mailing Address - Phone:707-656-8522
Mailing Address - Fax:
Practice Address - Street 1:2332 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1916
Practice Address - Country:US
Practice Address - Phone:707-656-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst