Provider Demographics
NPI:1245776145
Name:LOPEZ CRUZ, MARCO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:LOPEZ CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 WINGFIELD HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7220
Mailing Address - Country:US
Mailing Address - Phone:775-335-8292
Mailing Address - Fax:
Practice Address - Street 1:2350 WINGFIELD HILLS RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7220
Practice Address - Country:US
Practice Address - Phone:775-335-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-1298224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant