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NPI Code Detail

MEDICARE: MR. TONY SALAS CRUZ JR. M.A.

MEDICARE: MR. TONY SALAS CRUZ JR. M.A.
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
1101YM0800XMental Health CounselorLPC-115GU

General Provider Information

NPI Number : 1558701110
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TONY SALAS CRUZ JR. M.A.
Provider Business Mailing Address
First Line : 790 GOVERNOR CARLOS CAMACHO RD.,
Second Line :
City : TAMUNING
State : GU
Zip : 96913
Country : US
Telephone Number : 671-647-5440
Fax Number :
Provider Business Practice Location Address
First Line : 790 GOV CARLOS G CAMACHO RD
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3129
Country : US
Telephone Number : 671-647-5732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2013
Last Update Date : 09/17/2015

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