MEDICARE: SHERYL LEE O. DE LA CRUZ NP-C

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	363LF0000X	Family Nurse Practitioner	20133	CA

General Provider Information

NPI Number	:	1841584778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL LEE O. DE LA CRUZ NP-C

Provider Business Mailing Address
First Line	:	330 W RAMSEY ST
Second Line	:
City	:	BANNING
State	:	CA
Zip	:	92220-4823
Country	:	US
Telephone Number	:	951-849-1950
Fax Number	:	951-849-0080

Provider Business Practice Location Address
First Line	:	1850 S WATERMAN AVE STE D
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-891-1164
Fax Number	:	909-383-6689

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

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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