MEDICARE: CRUCITA MARIA MOREL

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	103K00000X	Behavior Analyst	P55-01745	NV

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	:	1740683929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRUCITA MARIA MOREL

Provider Business Mailing Address
First Line	:	3950 MOUNTAIN VISTA ST.
Second Line	:	123
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-418-8187
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 MOUNTAIN VISTA ST
Second Line	:	123
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4726
Country	:	US
Telephone Number	:	702-418-8187
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	08/07/2019

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