Provider Demographics
NPI:1154414571
Name:DELA CERNA, MARIA-LUISA C (PT)
Entity type:Individual
Prefix:MS
First Name:MARIA-LUISA
Middle Name:C
Last Name:DELA CERNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-656-6757
Mailing Address - Fax:
Practice Address - Street 1:2251 N SQUIRREL RD STE 310
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4608
Practice Address - Country:US
Practice Address - Phone:248-656-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-F3-6114-0OtherBLUE CROSS BLUE SHIELD
MI4670623Medicaid
MI65-0-F3-6114-0OtherBLUE CROSS BLUE SHIELD
MIP00380002Medicare ID - Type UnspecifiedMEMBER NUMBER