Provider Demographics
NPI:1912216656
Name:DE LA CRUZ, ELISE
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:
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:P.O. BOX 1043
Mailing Address - Street 2:
Mailing Address - City:HAMILTON CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95951
Mailing Address - Country:US
Mailing Address - Phone:530-826-3558
Mailing Address - Fax:
Practice Address - Street 1:564 RIO LINDO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1852
Practice Address - Country:US
Practice Address - Phone:530-879-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)