Healthcare Provider Details

I. General information

NPI: 1205654316
Provider Name (Legal Business Name): MRS. BERNADETTE DELA CRUZ OCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 H ST
CHULA VISTA CA
91910-4307
US

IV. Provider business mailing address

1623 GOLDEN GATE AVE
CHULA VISTA CA
91913-2927
US

V. Phone/Fax

Practice location:
  • Phone: 619-691-7360
  • Fax:
Mailing address:
  • Phone: 619-651-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number601811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: