Provider Demographics
NPI:1770378549
Name:CRUZ, OWEN CLYDE (RT)
Entity type:Individual
Prefix:
First Name:OWEN CLYDE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 W HORIZON RIDGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4429
Mailing Address - Country:US
Mailing Address - Phone:725-333-7124
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:6070 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-839-1114
Practice Address - Fax:702-380-1081
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3845227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered