Provider Demographics
NPI:1043020902
Name:DE LA LUZ, MARIA GABRIELA (COTA/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:DE LA LUZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42041 MOHAVE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7463
Mailing Address - Country:US
Mailing Address - Phone:661-604-3419
Mailing Address - Fax:
Practice Address - Street 1:44840 VALLEY CENTRAL WAY STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7261
Practice Address - Country:US
Practice Address - Phone:661-502-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7040224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant