1114088697 NPI number — DR. PAULA VANESSA DE LA CRUZ M.D.

Table of content: DR. PAULA VANESSA DE LA CRUZ M.D. (NPI 1114088697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114088697 NPI number — DR. PAULA VANESSA DE LA CRUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA CRUZ
Provider First Name:
PAULA
Provider Middle Name:
VANESSA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA CRUZ
Provider Other First Name:
VANESSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114088697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 ALAMEDA DE LAS PULGAS STE 235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94403-1185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-573-2043
Provider Business Mailing Address Fax Number:
650-573-2841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 EMELINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-1976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-454-4170
Provider Business Practice Location Address Fax Number:
831-454-4663
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  236555 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: A77095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ91891Z . This is a "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC 70042F . This is a "COUNTY OF SANTA CRUZ MEDI-CAL GROUP#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ92069Z . This is a "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC 70044F . This is a "COUNTY OF SANTA CRUZ MEDI-CAL GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91892Z . This is a "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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