Provider Demographics
NPI:1720210669
Name:DE LA CRUZ, CLARA YESENIA
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:YESENIA
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:YESENIA
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1401 S FEDERAL HWY.
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2619
Mailing Address - Country:US
Mailing Address - Phone:954-728-8080
Mailing Address - Fax:954-779-1957
Practice Address - Street 1:1401 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2619
Practice Address - Country:US
Practice Address - Phone:954-728-1083
Practice Address - Fax:954-779-2316
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker