Basic Information
| Provider Information | |||||||||
| NPI: | 1932266103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELA CRUZ | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | TOLENTINO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 78120 WILDCAT DR | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922111140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603402682 | ||||||||
| FaxNumber: | 7607739695 | ||||||||
| Practice Location | |||||||||
| Address1: | 78120 WILDCAT DR | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922111140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603402682 | ||||||||
| FaxNumber: | 7607739695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | A93803 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | A93803 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | A93803 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.