MEDICARE: MR. FRANK CRUZ JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		NV

General Provider Information

NPI Number	:	1164953881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK CRUZ JR.

Provider Business Mailing Address
First Line	:	3427 GONI RD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-8011
Country	:	US
Telephone Number	:	775-450-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 GONI RD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-8011
Country	:	US
Telephone Number	:	775-450-6999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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