Individual provider Active NPI

Carla Maria De la Cruz, MD

  • Anesthesiology Physician
  • San Diego, CA
National Provider Identifier
1700223294
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A172563 Issued in CA
Practice address
3626 Ruffin Rd
San Diego, CA 92123-1810
Phone
(858) 565-9666
NPI assigned
May 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD60963481 WA
Anesthesiology Physician 207L00000X A172563 CA Primary

Addresses

Primary practice location

3626 Ruffin Rd
San Diego, CA 92123-1810

Mailing address

3626 Ruffin Rd
San Diego, CA 92123-1810
Phone (858) 565-9666

Other identifiers 1

IdentifierTypeStateIssuer
1700223294MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210709001874 CA Practitioner - Anesthesiology 9830425362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Johns Hopkins University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Service Medical GroupGroup PAC ID 1153223219, 236 clinicians

Practice addresses (Care Compare)

3626 Ruffin Rd
San Diego, CA 92123-1810
Phone (619) 565-9666

Hospital & facility affiliations

  • Scripps Memorial Hospital - Encinitas Hospital, Encinitas, CA, CCN 050503

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A172563CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Service Medical Group Anesthesiology CurrentSince Jul 15, 2021 Accepting new patients

Locations

3626 Ruffin Rd
San Diego, CA 92123
Phone (619) 565-9666

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1700223294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-565-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-565-9666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA CRUZ",
        "first_name": "CARLA",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-24",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD60963481",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A172563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700223294",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.