Provider Demographics
NPI:1760074363
Name:DE LA CRUZ, CRISTIAN ENRIQUE (PT)
Entity type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:ENRIQUE
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9884 N HAVENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8904
Mailing Address - Country:US
Mailing Address - Phone:520-904-0924
Mailing Address - Fax:
Practice Address - Street 1:3601 W CORTARO FARMS RD STE 155
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-8674
Practice Address - Country:US
Practice Address - Phone:520-355-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist