Provider Demographics
NPI:1609526904
Name:DELACRUZ, HEATHER MICHEAL (PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHEAL
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 W VINE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8328
Mailing Address - Country:US
Mailing Address - Phone:559-303-4546
Mailing Address - Fax:
Practice Address - Street 1:4126 S DEMAREE ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9550
Practice Address - Country:US
Practice Address - Phone:559-303-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020501363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health