Provider Demographics
NPI:1922396258
Name:CRUZ OZAWA, EDILTRUDIS MAGALY (BS)
Entity Type:Individual
Prefix:
First Name:EDILTRUDIS
Middle Name:MAGALY
Last Name:CRUZ OZAWA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2885
Mailing Address - Country:US
Mailing Address - Phone:702-598-2020
Mailing Address - Fax:702-598-2018
Practice Address - Street 1:730 N EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2885
Practice Address - Country:US
Practice Address - Phone:702-598-2020
Practice Address - Fax:702-598-2018
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00178-LCI101YA0400X
225400000X
NVMI-0453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner