Provider Demographics
NPI:1861039893
Name:DELA CRUZ, ANGELINA IMBAT (RDH)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:IMBAT
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:DELACRUZ
Other - Last Name:SONGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:141 BRISAS ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7967
Mailing Address - Country:US
Mailing Address - Phone:760-212-5707
Mailing Address - Fax:
Practice Address - Street 1:BLDG 520448 BASILONE RD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31873124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist