Lourdes De la Cruz, M.D.
Individual provider Active NPI Pediatrics Physician · Oakley, CA
NPI 1699795237 · NPPES record last updated Nov 20, 2014
Key facts
- NPI
- 1699795237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- A42190 (CA)
- Practice address
- 3090 Frandoras Circle
Oakley, CA 94561 - Phone
- (925) 642-1742
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131113001003 | CA | Practitioner - Pediatric Medicine | 9739177072 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A42190 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Medical Centers, Inc. | Current | Accepting new patients | |
| Community Medical Centers Inc | Current |
Accepting new patients | |
| Community Medical Centers, Inc | Current |
Accepting new patients | |
| Sutter East Bay Medical Foundation | Past | Accepting new patients | |
| Sutter East Bay Medical Foundation | Past | Accepting new patients |
Locations
7210 Murray Dr
Stockton, CA 95210
Phone (209) 373-2816
730 N Central Ave
Tracy, CA 95376
Phone (209) 820-1500
Interoperability endpoints
- lourdes.delacruz.p1@direct.cmcentersinc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A42190 | CA | Yes |
Addresses
Primary practice location
3090 Frandoras Circle
Oakley, CA 94561
Mailing address
3090 Frandoras Circle
Oakley, CA 94561
Phone (925) 642-1742
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A421900 | Medicaid | CA |
Other providers in Oakley, CA
- Brianne-Clair Lili Curtis
- Nkiruka Daniel-Enenta
- Richard John Dare
- Ashley Davilla
- Kathleen Marie Davison
- Cecil Ting De Lara
- Faviola Diaz
- Jacob Fermin Duenas
- Samantha Dumenigo
- Ecolux Retreats, Inc.
All providers in Oakley, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.