Provider Demographics
NPI:1699843037
Name:DE LA CRUZ, DIANA LYNN (PT)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:LYNN
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CAMINO PALMERO ST
Mailing Address - Street 2:APT. 326
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2945
Mailing Address - Country:US
Mailing Address - Phone:323-378-6804
Mailing Address - Fax:
Practice Address - Street 1:1745 CAMINO PALMERO ST APT 326
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2909
Practice Address - Country:US
Practice Address - Phone:323-366-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021434225100000X
CA34187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist