Healthcare Provider Details

I. General information

NPI: 1518116730
Provider Name (Legal Business Name): MR. HENRIQUEZ DELACRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DRIVE PROSTHETIC & SENSORY AIDS SVC 664/121
SAN DIEGO CA
92161
US

IV. Provider business mailing address

3350 LA JOLLA VILLAGE DRIVE PROSTHETIC & SENSORY AIDS SVC 664/121
SAN DIEGO CA
92161
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-1152
  • Fax: 858-642-1471
Mailing address:
  • Phone: 858-642-1152
  • Fax: 858-642-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: