Provider Demographics
NPI:1790709004
Name:DELACRUZ, MANUEL
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 CODY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5933
Mailing Address - Country:US
Mailing Address - Phone:951-352-4349
Mailing Address - Fax:
Practice Address - Street 1:217 W. CERRITOS BLDG #8
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805
Practice Address - Country:US
Practice Address - Phone:714-257-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health