Healthcare Provider Details

I. General information

NPI: 1144135252
Provider Name (Legal Business Name): TRACY DELACRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

10212 KENMORE ST
ANAHEIM CA
92804-5171
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-7066
  • Fax:
Mailing address:
  • Phone: 714-644-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number572629
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number4797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: