Provider Demographics
NPI:1326220310
Name:CRUZADO, EDWARD CREENCIA
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CREENCIA
Last Name:CRUZADO
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 1:800 N RAINBOW BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1189
Mailing Address - Country:US
Mailing Address - Phone:702-948-5187
Mailing Address - Fax:702-948-7616
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-948-5187
Practice Address - Fax:702-948-7616
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies