Provider Demographics
NPI:1841584778
Name:DE LA CRUZ, SHERYL LEE O (NP-C)
Entity Type:Individual
Prefix:
First Name:SHERYL LEE
Middle Name:O
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-4823
Mailing Address - Country:US
Mailing Address - Phone:951-849-1950
Mailing Address - Fax:951-849-0080
Practice Address - Street 1:1850 S WATERMAN AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2852
Practice Address - Country:US
Practice Address - Phone:909-891-1164
Practice Address - Fax:909-383-6689
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily