Provider Demographics
NPI:1558887620
Name:DELACRUZ, KIM (LAC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1917
Mailing Address - Country:US
Mailing Address - Phone:858-204-5676
Mailing Address - Fax:
Practice Address - Street 1:570 LAGUNA DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1607
Practice Address - Country:US
Practice Address - Phone:760-452-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8579171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist