MEDICARE: JUSTIN DE LA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	307229	CA

General Provider Information

NPI Number	:	1407667637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN DE LA CRUZ

Provider Business Mailing Address
First Line	:	7281 LONE PINE DR STE D103
Second Line	:
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9715
Country	:	US
Telephone Number	:	916-354-0719
Fax Number	:

Provider Business Practice Location Address
First Line	:	7281 LONE PINE DR STE D103
Second Line	:
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9715
Country	:	US
Telephone Number	:	916-354-0719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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Directions to “ JUSTIN DE LA CRUZ ” Practice Location

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