Provider Demographics
NPI:1588016489
Name:DELACRUZ, CESIA (LVN)
Entity type:Individual
Prefix:
First Name:CESIA
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CESIA
Other - Middle Name:
Other - Last Name:BARAHONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:717 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2845
Mailing Address - Country:US
Mailing Address - Phone:310-399-9883
Mailing Address - Fax:310-399-9678
Practice Address - Street 1:717 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291
Practice Address - Country:US
Practice Address - Phone:310-399-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247191164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse