Provider Demographics
NPI:1710691282
Name:DE LA CRUZ SANTAMARIA, RODRIGO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:JAVIER
Last Name:DE LA CRUZ SANTAMARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1201 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:559-366-7060
Practice Address - Street 1:1201 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2233
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-366-7060
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAP18208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty