Provider Demographics
NPI:1508288382
Name:DE LA CRUZ, DEBRA RAY
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RAY
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 1:525 N V ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5119
Mailing Address - Country:US
Mailing Address - Phone:805-736-0382
Mailing Address - Fax:
Practice Address - Street 1:525 N V ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5119
Practice Address - Country:US
Practice Address - Phone:805-736-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor