MEDICARE: LEILA CRUZ CONWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1841564671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA CRUZ CONWAY

Provider Business Mailing Address
First Line	:	1600 PACIFIC TIDE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6846
Country	:	US
Telephone Number	:	619-240-5031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 PACIFIC TIDE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6846
Country	:	US
Telephone Number	:	619-240-5031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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Directions to “ LEILA CRUZ CONWAY ” Practice Location

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