Provider Demographics
NPI:1811176829
Name:DE LA CRUZ, ROBERTA
Entity type:Individual
Prefix:MS
First Name:ROBERTA
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 1:8337 TELEGRAPH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4957
Mailing Address - Country:US
Mailing Address - Phone:562-207-4272
Mailing Address - Fax:562-207-4279
Practice Address - Street 1:8337 TELEGRAPH RD STE 300
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4957
Practice Address - Country:US
Practice Address - Phone:562-207-4272
Practice Address - Fax:562-207-4279
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty