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General NPI Number Information
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NPI Number | 1114549953
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Entity Type | Individual
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Provider Name | REGINA ISABEL DE LA CRUZ DMD
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 12360 FIRESTONE BLVD
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City | NORWALK
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State | CA
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Zip | 90650-4324
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Country | US
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Telephone | 866-733-5924
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Fax |
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Provider Business Mailing Address
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Address Line | 6589 COUNTRY WINDS CV
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City | LAKE WORTH
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State | FL
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Zip | 33463-7433
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Country | US
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Telephone | 561-543-9470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106828
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License Number State | CA
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