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1104205699
JOSE DE LA CRUZ
INDIO, CA
NPI
1104205699
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA CADTP#1483)
Enumeration Date
2015-05-29
Last Update Date
2015-05-29
Business Address
Mr. JOSE DE LA CRUZ
45550 GRACE ST
INDIO, CA 92201-4610
Phone number: 760-342-1233
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Mailing Address
Mr. JOSE DE LA CRUZ
45550 GRACE ST
INDIO, CA 92201-4610
Phone number: 760-342-1233
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