Provider Demographics
NPI:1922504505
Name:CRUZ, LUIS ANGEL (CASAC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ANGEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1740 MULFORD AVE APT 18A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4335
Mailing Address - Country:US
Mailing Address - Phone:917-270-4131
Mailing Address - Fax:718-828-4899
Practice Address - Street 1:1510 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2700
Practice Address - Country:US
Practice Address - Phone:347-493-8541
Practice Address - Fax:718-828-4899
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)