Provider Demographics
NPI:1144815689
Name:DELACRUZPORTUGAL, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DELACRUZPORTUGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8873 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-0054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9681 BUSINESS CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4579
Practice Address - Country:US
Practice Address - Phone:909-710-5752
Practice Address - Fax:909-363-8773
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist