Provider Demographics
NPI:1053388173
Name:DELACRUZ, NELSON M (DDS)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:M
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 3RD ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3729
Mailing Address - Country:US
Mailing Address - Phone:562-923-0038
Mailing Address - Fax:562-923-8563
Practice Address - Street 1:8207 3RD ST
Practice Address - Street 2:SUITE #106
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3729
Practice Address - Country:US
Practice Address - Phone:562-923-0038
Practice Address - Fax:562-923-8563
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice