Healthcare Provider Details

I. General information

NPI: 1255445300
Provider Name (Legal Business Name): RHODORA C. DELA CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 MOWRY AVE SUITE A2
FREMONT CA
94538-1724
US

IV. Provider business mailing address

2147 MOWRY AVE SUITE A2
FREMONT CA
94538-1724
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-1030
  • Fax: 510-790-6512
Mailing address:
  • Phone: 510-793-1030
  • Fax: 510-790-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBD3126756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: