MEDICARE: MR. ABRAHAM CRUZ DIAZ JR. LCSW

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	1041C0700X	Clinical Social Worker	5652-C	NV

General Provider Information

NPI Number	:	1528121878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABRAHAM CRUZ DIAZ JR. LCSW

Provider Business Mailing Address
First Line	:	10315 PARKVIEW MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5012
Country	:	US
Telephone Number	:	702-901-4227
Fax Number	:

Provider Business Practice Location Address
First Line	:	10315 PARKVIEW MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5012
Country	:	US
Telephone Number	:	702-901-4227
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/27/2015

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