Provider Demographics
NPI:1114549953
Name:DE LA CRUZ, REGINA ISABEL (DMD)
Entity type:Individual
Prefix:DR
First Name:REGINA ISABEL
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:CHUA
Other - Last Name:DELACRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6589 COUNTRY WINDS CV
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7433
Mailing Address - Country:US
Mailing Address - Phone:561-543-9470
Mailing Address - Fax:
Practice Address - Street 1:12360 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4324
Practice Address - Country:US
Practice Address - Phone:866-733-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1068281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice