Provider Demographics
NPI:1861779951
Name:DE LA CRUZ, JOSEPH SOLORIO JR (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SOLORIO
Last Name:DE LA CRUZ
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:14626 HUMMINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7573
Mailing Address - Country:US
Mailing Address - Phone:760-998-7815
Mailing Address - Fax:
Practice Address - Street 1:I MEF CREDENTIALING (RM 4172)
Practice Address - Street 2:NMRTC CAMP PENDLETON
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1710I1002X, 363A00000X
CA60413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman