Provider Demographics
NPI:1952956617
Name:DELA CRUZ, JEANETTE (COTA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:DELA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JEANETTE SORIANO
Mailing Address - Street 1:16428 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1804
Mailing Address - Country:US
Mailing Address - Phone:818-404-6824
Mailing Address - Fax:818-404-6824
Practice Address - Street 1:16428 BALLINGER ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-1804
Practice Address - Country:US
Practice Address - Phone:818-404-6824
Practice Address - Fax:818-404-6824
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424022224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA224Z00000XOtherGENESIS REHAB