Healthcare Provider Details

I. General information

NPI: 1982146387
Provider Name (Legal Business Name): JOSE CRUZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MED PARK DR
LAS CRUCES NM
88005-3236
US

IV. Provider business mailing address

301 PERKINS DR STE C
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-7243
  • Fax: 575-525-5641
Mailing address:
  • Phone: 575-523-7243
  • Fax: 575-525-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1628
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: