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Organization
LEGACY OUTPATIENT THERAPY SERVICES
Active
Organization
LEGACY OUTPATIENT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL RAIZA DELA CRUZ BSN, RN, MSN, FNP-C (CEO)
(562) 467-0777
Entity
Organization
Contact information
Practice address
11618 SOUTH ST UNIT 201, ARTESIA, CA 90701
(562) 467-0777
(562) 683-3047
Mailing address
11618 SOUTH ST # 201, ARTESIA, CA 90701-6618
(562) 467-0777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
03/20/2018
Last updated
01/10/2019
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