Provider Demographics
NPI:1326574484
Name:ANTONIO CRUZ
Entity Type:Organization
Organization Name:ANTONIO CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-461-4282
Mailing Address - Street 1:263 SPRING HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2502
Mailing Address - Country:US
Mailing Address - Phone:954-461-4282
Mailing Address - Fax:
Practice Address - Street 1:263 SPRING HOLLOW DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2502
Practice Address - Country:US
Practice Address - Phone:954-461-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management