Provider Demographics
NPI:1659578359
Name:CHRISTOPHER S CRUZ MD LTD
Entity Type:Organization
Organization Name:CHRISTOPHER S CRUZ MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-220-9667
Mailing Address - Street 1:PO BOX 28971
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-2971
Mailing Address - Country:US
Mailing Address - Phone:702-220-9667
Mailing Address - Fax:702-220-5277
Practice Address - Street 1:5450 W SAHARA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0380
Practice Address - Country:US
Practice Address - Phone:702-220-9667
Practice Address - Fax:702-220-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH91537Medicare UPIN
NVV37882Medicare PIN