Healthcare Provider Details

I. General information

NPI: 1306750518
Provider Name (Legal Business Name): NICO PAOLO DELA CRUZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 HUNTINGTON DR
DUARTE CA
91010-2101
US

IV. Provider business mailing address

2362 HUNTINGTON DR
DUARTE CA
91010-2101
US

V. Phone/Fax

Practice location:
  • Phone: 626-733-6136
  • Fax:
Mailing address:
  • Phone: 626-733-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: