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General NPI Number Information
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NPI Number | 1982983110
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Entity Type | Individual
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Provider Name | MANUEL DELA CRUZ MARTIN
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Gender | Male
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1700 MOUNT VERNON AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93306-4018
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Country | US
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Telephone | 661-326-2715
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Fax |
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Provider Business Mailing Address
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Address Line | 9941 N SEDONA CIR
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City | FRESNO
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State | CA
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Zip | 93720-5410
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Country | US
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Telephone | 559-314-4114
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 749551
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License Number State | CA
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