Provider Demographics
NPI:1891313680
Name:DELACRUZ, SAMANTHA R
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:DELACRUZ
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 1:1150 E SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4508
Mailing Address - Country:US
Mailing Address - Phone:559-556-0030
Mailing Address - Fax:559-556-0030
Practice Address - Street 1:1150 E SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4508
Practice Address - Country:US
Practice Address - Phone:559-556-0030
Practice Address - Fax:559-556-0030
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other