1952956617 NPI number — JEANETTE DELA CRUZ COTA

Table of content: JEANETTE DELA CRUZ COTA (NPI 1952956617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952956617 NPI number — JEANETTE DELA CRUZ COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELA CRUZ
Provider First Name:
JEANETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELA CRUZ
Provider Other First Name:
JEANETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
JEANETTE SORIANO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952956617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16428 BALLINGER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91343-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-404-6824
Provider Business Mailing Address Fax Number:
818-404-6824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16428 BALLINGER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-404-6824
Provider Business Practice Location Address Fax Number:
818-404-6824
Provider Enumeration Date:
08/08/2019

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: 224Z00000X , with the licence number:  424022 , 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: 224Z00000X . This is a "GENESIS REHAB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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