Individual
DARLA ANN FONSECA DE LA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-8001
Mailing address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-8001
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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