Provider Demographics
NPI:1437637170
Name:CRUZ, OLIVER CHAD ONG (OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVER CHAD
Middle Name:ONG
Last Name:CRUZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5576 JINSHA RIVER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7712
Mailing Address - Country:US
Mailing Address - Phone:702-523-2758
Mailing Address - Fax:
Practice Address - Street 1:5576 JINSHA RIVER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7712
Practice Address - Country:US
Practice Address - Phone:702-523-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16-0711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist