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General NPI Number Information
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NPI Number | 1063079234
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Entity Type | Individual
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Provider Name | JIMMY CRUZA FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2 S MAINE AVE BLDG 102-54
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City | HAWTHORNE
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State | NV
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Zip | 89415-9404
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Country | US
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Telephone | 702-981-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 7113 BLUEBIRD WING ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-4802
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Country | US
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Telephone | 702-981-2919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 821250
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License Number State | NV
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