MEDICARE: WASCAR CRUZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225400000X	Rehabilitation Practitioner
2	251S00000X	Community/Behavioral Health Agency
3	261QM0850X	Adult Mental Health Clinic/Center
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932537255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WASCAR CRUZ

Provider Business Mailing Address
First Line	:	9525 KICKAPOO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2398
Country	:	US
Telephone Number	:	702-352-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	8430 W LAKE MEAD BLVD STE 139
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7672
Country	:	US
Telephone Number	:	702-489-5050
Fax Number	:	702-485-5207

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

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	05/10/2022

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Directions to “ WASCAR CRUZ ” Practice Location

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