Individual
KYLE JOSEPH DELA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 239-8101
(503) 408-5201
Mailing address
424 NE 22ND AVE, PORTLAND, OR 97232-2809
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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