Healthcare Provider Details

I. General information

NPI: 1265129985
Provider Name (Legal Business Name): RACHEL ANN CRUZ GUIKING COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 PASEO VERDE PKWY STE 155
HENDERSON NV
89074-7121
US

IV. Provider business mailing address

5453 S DURANGO DR UNIT 1004
LAS VEGAS NV
89113-2259
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 757-995-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-2148
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: