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General NPI Number Information
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NPI Number | 1356094460
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Entity Type | Individual
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Provider Name | SIERRA CRUZ LAT ATC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 08/27/2023
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Provider Practice Location Address
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Address Line | 120 SILVER LAKE RD
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1225
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Country | US
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Telephone | 302-867-0423
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HUNTER RD
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City | NEW CASTLE
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State | DE
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Zip | 19720-1715
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Country | US
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Telephone | 302-867-0423
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | J3-0010912
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License Number State | DE
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