Provider Demographics
NPI:1225378557
Name:CRUZ, MELANIE BRIGINO
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BRIGINO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 E HACIENDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1814
Mailing Address - Country:US
Mailing Address - Phone:702-480-4858
Mailing Address - Fax:
Practice Address - Street 1:1168 E HACIENDA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1814
Practice Address - Country:US
Practice Address - Phone:702-480-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4309AGC10103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst