Active NPI
Jacklyn De la Cruz, OTR/L
- Occupational Therapist
- Riverside, CA
National Provider Identifier
1003587304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 15015
- Practice address
- 9025 Colorado Ave
Riverside, CA 92503-2157 - Phone
- (951) 688-3636
- NPI assigned
- Sep 26, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Low Vision Occupational Therapy Assistant | 224ZL0004X | |||
| Occupational Therapist | 225X00000X | 15015 | CA | Primary |
Addresses
Primary practice location
9025 Colorado Ave
Riverside, CA 92503-2157
Mailing address
4195 Chino Hills Pkwy # 421
Chino Hills, CA 91709-2618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15015 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1003587304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4195 CHINO HILLS PKWY # 421",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917092618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9025 COLORADO AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925032157",
"telephone_number": "951-688-3636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA CRUZ",
"first_name": "JACKLYN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-26",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "224ZL0004X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant, Low Vision",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "15015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.