Provider Demographics
NPI:1952489858
Name:DELA CRUZ, LINA C (MD)
Entity type:Individual
Prefix:
First Name:LINA
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 1:140 N ORANGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2032
Mailing Address - Country:US
Mailing Address - Phone:626-800-1200
Mailing Address - Fax:
Practice Address - Street 1:140 N ORANGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2032
Practice Address - Country:US
Practice Address - Phone:626-800-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A694210Medicaid
00A694210Medicare ID - Type Unspecified
H08968Medicare UPIN