Provider Demographics
NPI:1861849374
Name:DE LA CRUZ, AMY GABRIELA
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GABRIELA
Last Name:DE LA 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 1:849 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1026
Mailing Address - Country:US
Mailing Address - Phone:213-623-8446
Mailing Address - Fax:213-896-1880
Practice Address - Street 1:849 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1026
Practice Address - Country:US
Practice Address - Phone:213-623-8446
Practice Address - Fax:213-896-1880
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAAMFT142931106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist