Provider Demographics
NPI:1629617592
Name:DELA CRUZ, MOIRA (RN)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 METROPOLITAN DR STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4424
Mailing Address - Country:US
Mailing Address - Phone:619-688-6190
Mailing Address - Fax:
Practice Address - Street 1:510 CAMINO DE LA REINA UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3128
Practice Address - Country:US
Practice Address - Phone:619-757-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse