Individual
MRS. LOU MIZELLE DELACRUZ TANWANGCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1906 COMMERCENTER E STE 100, SAN BERNARDINO, CA 92408-3423
(909) 478-7776
(909) 478-7768
Mailing address
491 S LA SALLE ST, REDLANDS, CA 92374-6472
(909) 709-2045
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17755
CA
Other
Enumeration date
03/23/2007
Last updated
12/01/2011
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