MEDICARE: DAGMAR DE LA CRUZ

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	3747P1801X	Personal Care Attendant
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588163083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAGMAR DE LA CRUZ

Provider Business Mailing Address
First Line	:	3543 WINGROVE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 E FLAMINGO RD STE 212
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	702-981-1484
Fax Number	:	702-995-0242

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	01/20/2026

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Directions to “ DAGMAR DE LA CRUZ ” Practice Location

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