Healthcare Provider Details

I. General information

NPI: 1891537536
Provider Name (Legal Business Name): NIKKI CHRISTIAN DELACRUZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

19733 ALYSSA DR
SANTA CLARITA CA
91321-2144
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8051
  • Fax:
Mailing address:
  • Phone: 661-312-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95030526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: