Provider Demographics
NPI:1629012422
Name:DE LA CRUZ, APRIL LYNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:LYNETTE
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17259 JASMINE ST STE B
Mailing Address - Street 2:POB 1537
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7787
Mailing Address - Country:US
Mailing Address - Phone:760-951-7778
Mailing Address - Fax:760-241-5950
Practice Address - Street 1:17259 JASMINE ST
Practice Address - Street 2:STE B
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7787
Practice Address - Country:US
Practice Address - Phone:760-951-7778
Practice Address - Fax:760-241-5950
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA172820Medicaid
CA0PA172820Medicaid