Healthcare Provider Details

I. General information

NPI: 1083005672
Provider Name (Legal Business Name): SONIA DELACRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18411 CLARK ST SUITE 302
TARZANA CA
91356-3506
US

IV. Provider business mailing address

18411 CLARK ST SUITE 302
TARZANA CA
91356-3506
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7276
  • Fax: 818-996-7288
Mailing address:
  • Phone: 818-501-7276
  • Fax: 818-996-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA62510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: