Provider Demographics
NPI:1447689245
Name:DE LA CRUZ CARRILLO, LILIANA
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:DE LA CRUZ CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S HOPE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2913
Mailing Address - Country:US
Mailing Address - Phone:213-381-8500
Mailing Address - Fax:213-381-8515
Practice Address - Street 1:1355 S HOPE ST APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2913
Practice Address - Country:US
Practice Address - Phone:213-381-8500
Practice Address - Fax:213-381-8515
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)