Provider Demographics
NPI:1710623442
Name:DE LA CRUZ CARDENAS, CINTHYA NAYELI (PA-C)
Entity type:Individual
Prefix:
First Name:CINTHYA
Middle Name:NAYELI
Last Name:DE LA CRUZ CARDENAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-4331
Mailing Address - Country:US
Mailing Address - Phone:626-428-2939
Mailing Address - Fax:
Practice Address - Street 1:801 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6614
Practice Address - Country:US
Practice Address - Phone:714-633-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0050X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program