Provider Demographics
NPI:1760629570
Name:DELA CRUZ, MARY ANNE VARGAS
Entity Type:Individual
Prefix:MISS
First Name:MARY ANNE
Middle Name:VARGAS
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 LINDEN AVE
Mailing Address - Street 2:220
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4538
Mailing Address - Country:US
Mailing Address - Phone:562-426-6803
Mailing Address - Fax:
Practice Address - Street 1:3565 LINDEN AVE.
Practice Address - Street 2:220
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-426-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64695126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant