Provider Demographics
NPI:1255445300
Name:DELA CRUZ, RHODORA C (MD)
Entity type:Individual
Prefix:
First Name:RHODORA
Middle Name:C
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 MOWRY AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1724
Mailing Address - Country:US
Mailing Address - Phone:510-793-1030
Mailing Address - Fax:510-790-6512
Practice Address - Street 1:2147 MOWRY AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1724
Practice Address - Country:US
Practice Address - Phone:510-793-1030
Practice Address - Fax:510-790-6512
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABD3126756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505321OtherMEDICAL