Healthcare Provider Details

I. General information

NPI: 1932731452
Provider Name (Legal Business Name): TINA MARIE DELACRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 07/24/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARMEN LN STE A
SANTA MARIA CA
93458-7768
US

IV. Provider business mailing address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax:
Mailing address:
  • Phone: 805-934-6324
  • Fax: 805-934-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-NEOJQT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: