Healthcare Provider Details

I. General information

NPI: 1104752021
Provider Name (Legal Business Name): LESLIE GUADALUPE DE LA CRUZ-TREJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E ROSECRANS AVE APT C
EAST RANCHO DOMINGUEZ CA
90221-2193
US

IV. Provider business mailing address

1212 E ROSECRANS AVE APT C
EAST RANCHO DOMINGUEZ CA
90221-2193
US

V. Phone/Fax

Practice location:
  • Phone: 323-407-0870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: