Healthcare Provider Details

I. General information

NPI: 1770378549
Provider Name (Legal Business Name): OWEN CLYDE CRUZ RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S FORT APACHE RD STE 110
LAS VEGAS NV
89148-5615
US

IV. Provider business mailing address

2821 W HORIZON RIDGE PKWY STE 101
HENDERSON NV
89052-4429
US

V. Phone/Fax

Practice location:
  • Phone: 702-839-1114
  • Fax: 702-380-1081
Mailing address:
  • Phone: 725-333-7124
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3845
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: