Provider Demographics
NPI:1457829822
Name:LOPEZ, ASUZENA CRUZ
Entity Type:Individual
Prefix:
First Name:ASUZENA
Middle Name:CRUZ
Last Name:LOPEZ
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 1:6155 AMOS DR
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-4769
Mailing Address - Country:US
Mailing Address - Phone:775-304-7951
Mailing Address - Fax:
Practice Address - Street 1:250 LAMOILLE HW
Practice Address - Street 2:SUITE 103
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-777-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician