Healthcare Provider Details

I. General information

NPI: 1225713712
Provider Name (Legal Business Name): KRISTINA CASANDRA LLANEZA CRUZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 E WARM SPRINGS RD
LAS VEGAS NV
89120-3157
US

IV. Provider business mailing address

3211 E WARM SPRINGS RD
LAS VEGAS NV
89120-3157
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-5848
  • Fax:
Mailing address:
  • Phone: 702-912-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT2315
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: