1073283578 NPI number — LERMA D DE LA CRUZ CNA, CAREGIVER

Table of content: LERMA D DE LA CRUZ CNA, CAREGIVER (NPI 1073283578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073283578 NPI number — LERMA D DE LA CRUZ CNA, CAREGIVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA CRUZ
Provider First Name:
LERMA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA, CAREGIVER
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:
EMMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073283578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2112 E MORELOS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85225-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-748-4387
Provider Business Mailing Address Fax Number:
480-748-4387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 E MORELOS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85225-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-748-4387
Provider Business Practice Location Address Fax Number:
480-748-4387
Provider Enumeration Date:
09/16/2021

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: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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