Basic Information
| Provider Information | |||||||||
| NPI: | 1154414571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELA CERNA | ||||||||
| FirstName: | MARIA-LUISA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2251 N SQUIRREL RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483264600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486566757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2251 N SQUIRREL RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483264608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486566757 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 10/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501005717 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 65-0-F3-6114-0 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 4670623 | 05 | MI | MEDICAID |