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General NPI Number Information
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NPI Number | 1932537255
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Entity Type | Individual
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Provider Name | WASCAR CRUZ
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Gender | Male
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 8430 W LAKE MEAD BLVD STE 139
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City | LAS VEGAS
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State | NV
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Zip | 89128-7672
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Country | US
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Telephone | 702-489-5050
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Fax | 702-485-5207
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Provider Business Mailing Address
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Address Line | 9525 KICKAPOO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89149-2398
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Country | US
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Telephone | 702-352-8888
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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