Provider Demographics
NPI:1972921989
Name:DE LA CRUZ, ALYSSA NORA (MOT)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:NORA
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 KNOLLHILL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2117
Mailing Address - Country:US
Mailing Address - Phone:214-668-8394
Mailing Address - Fax:
Practice Address - Street 1:45 NW INTERSTATE 410 LOOP FROUNTAGE RD #690
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5832
Practice Address - Country:US
Practice Address - Phone:210-457-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113581225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics